Dear Anon..
Having a nerve sparing radical prostatectomy means that your surgeon attempted to avoid the nerves enervating your bladder and bladder neck. Unfortunately it sounds as if the attempt was not entirely successful. The lack of sensation in your bladder as well as continued incontinence despite kegels would indicate to me that you do have some nerve damage. While it is true that some people get better with kegels; it is also true that most individuals do not do them correctly. I will take a moment to address this issue. Kegel exercise is simply exercising the pelvic floor muscle group. This involves the muscles from the anus to the penis. Basically you contract the muscles lifting them up and slightly backwards. When contracting these muscles nothing else should move, not your buttocks, legs or abdomen. Most people make the mistake of using one or more of these muscle groups, this is called recruitment. Using undesireable muscles can block progress and even make your situation worse. Additionally, it is important to think of your exercise program in the same fashion would a body buidling program. Your objectives are the same to increase the size and strength of the muscle group you are working. I typically assign my patients to do 5 sec contractions with 5 sec relaxation (this equals one repetition) x 25 reps four different times a day but only every other day. This allows for the muscle to recover after being slightly torn down one day. At the end of each of your 25 reps do an additional 5 reps of quick flicks. A quick flick is two quick contractions and a 5 sec relaxation period. As this regimen becomes easier, either add to the number of repetitions or increase the hold time. If you increase the hold time it may be necessary for you to decrease slightly the number of reps at first then add them back in as able. In this seesaw fashion you will continually challenge your muscles to grow in strength and bulk. Kegels are basically a for the rest of your life routine. However, if and when you reach your goal of continence you can generally go to a maintenance routine of exercising 2-3 x per week. It is difficult to address some of your other questions simply because I don't know a lot of things about you. Do you have any other health problems? Particularly diabetes, hypertention, any neurological disorder, a history of serious back injury or surgery. What medicines are you on, particularly diuretics? Although you are incontinent you could also have urinary retention. Do you know if you empty your bladder completely? Your incontinence could be stress, urge or overflow in nature. The fact that you do not wet the bed leads me to believe you do not have overflow incontinence. The nature of your surgery would incline me to believe you have mostly stress but you could also have an urge component. Detrol will help if you have an urge component but sometimes it is difficult to see the result of the detrol on the urge component if the stress component is severe. As you can see this is a complicated problem. If you feel you've given kegels a fair shot after reading my suggestions above and you doubt you have much urge component then you have several options to deal with the stress component. Collagen injection around the bladder neck is an easy in and out procedure with little to no side effects. Basically what the collagen does is bulk up the area around the bladder neck making it easier for the sphincter to close completely. There is a 30 day waiting period after a skin test to insure that you will not have an allergic reaction to the collagen. Sometimes it takes 2 or rarely 3 injections to get completely dry. The collagen is naturally absorbed by the body and eventually will have to be repeated (generally every 2 - 3 years). Trying collagen does not burn any bridges. In other words it does not prevent you from trying something else if you are unsatisfied with the results. The bad news is not all urologist are experienced and/or believe in collagen. My doctors use it quite frequenctly with great success. The other option is an artificial sphincter. Basically this is a device that is surgically implanted and places a cuff around the urethra. It can be manually deflated to allow voiding. The problems with this are fairly obvious. It is an extensive surgery. There is a risk of infection and/or rejection. Sometimes you get a faulty device. Not every urologist has experience with this type of surgery and I would be especially careful if you are considering it to ask how many the urologist has previously done. I would also ask to speak to some of their patients that have had it done. I am not sure why you have the left kidney pain, it makes me wonder if you have reflux but there is not enough to go on here. I cannot address the renal damage secondary to blood pressure dropping during surgery issue. Your fluctuation in frequency and volume are probably most like related to what your are drinking. Foul urine odor can be a sign of infection, concentrated urine or simply the result of something you ate. If you doubt me try eating asparagus and see how your urine smells. Lastly try the american urological associations website to help you locate a urologist. http://auanet.org. Best of luck, if I can be of further help let me know.