BrownBobby

Agreed (and thanks for the tag!) - there is a world where I see this working but I don't know if you want to go down it. I'm sitting here as I type this in a 24fr cath stretching out my stricture, draining into my diaper...but even then, I know the VERY real risks that come with this, even if I'm minimizing them. Even if you keep sizing up your stent, you have the rest of the urinary system to get through first to get to where you want to seat it. Unless you want to start scarring things along the way, you'll need to stretch those out just as much as the other muscles. A cath is ideal for this - a stent, less so. Now, there is *another* way I can see stenting making you more incontinent - urge incontinence. If you keep your bladder draining as soon as it fills, it will atrophy and lose its elasticity. When it can't stretch as much, you'll need to go more often, in smaller amounts, and with greater urgency. Keep stenting for long enough, and I bet you could make that pretty darn powerful. And once you get past the point of no return, it self-perpetuates. It's pretty hard to hold it and stretch your bladder when you only have a few seconds before you're wetting yourself. At the end of the day? If you want to try it, more power to you! I won't discourage anyone from it. But only when they have a good idea of the risks and effectiveness of what they're attempting.

Oh, if you only knew the methods I tried first. I’m probably one of the experts in the field of purposely inducing and developing incontinence with all I exhausted. Ten years of 24/7 diapers. Hypnosis. Behavioral training. Catheters. Physical therapy. Standard mental health therapy. Trauma processing. Prescribed meds. Illegally sourced meds (note: don’t do this one - the ER trip was not fun, and what led to me starting to find urologists seriously.) This is why this question is especially one that I have trouble with people asking. It’s easy to “armchair diagnose” about what other options there are and conclude it isn’t necessary. But gods, the weight off my shoulders when I sat up a week after my revision surgery and just…wet myself. It was divine. Nothing else even came close to that level of satisfying that maddening compulsion and desire. If the cost of my mental health and satisfaction is a one-way ticket to wet pants for the rest of my life, gods am I glad I paid it.

Considering this is the framework that multiple urologists used when working with me…I think you got the right answer here. I won’t fault anyone for not wanting the risk, but dang it’d be nice to have a framework instead of having to hack it together, for a willing surgeon to do an operation with reasonable assurance it’d improve their life and not lead to a lawsuit.

Alright. Three things I can help with here - and feel a need to, given my experience and research. Dr. Aguilar's qualifications extend even beyond what @nareh60280 listed. Before starting his transgender practice, his urological specialty was continence. He has been nothing but professional in working with me the entire time I worked with him, and while there may be doctors out there who deserve skepticism and judgement, he's not one of them. He made it clear what the results were be, made sure I wanted it, and did it with professionalism and sincerity. I wish all my interactions with doctors were like this one. If you don't believe me, just look around the internet for the dozens of others who have positive experiences with transgender and other operations - it's what led me to trust him with my own procedure. Realistically, even an open-minded doctor isn't going to pursue a stent as a way to induce incontinence. In talking with the urologists who consulted with me on my own incontinence journey (all of which knew fully well I had a healthy urinary system I wanted to make incontinent deliberately), stents were pretty much the only thing 100% off the table. There's so many risks to them that it's become best practice to look for any other methods you can (and yes, the research is there to back that too, if you start looking through journals.) Between encrustation, migration, ingrowth, blockages, and the like...most urologists will just tell you to cath if you want to do something like it. So given that... Why does @Wolle have a study recommending it? Read through it a bit closer, and the picture becomes clearer. The test subjects were four elderly individuals for whom other methods - medications, TURP, etc. - aren't available. But even the authors acknowledge the very real risks - they selected the particular type of stent because if the complications they expected did arise, it would be the least worst to get out. (Not easiest - least worst). You'll find the research recommending these stents starts taking a turn around in the mid 2010's, as the failure rates for these stents became more widely known in longer-term studies. Currently, stents like this are seen as an option of last resort, if nothing else works. This leaves...frustratingly few other options that I'm aware of at the moment. Unsurprisingly, there isn't much research into inducing temporary urinary incontinence (especially with catheterization available), while permanent incontinence has a greater body of research due to conditions like DSD. If you're going to stent, my recommendation is to get really familiar with the best practices for it (documented here and other places), and then find a professional who's willing to advise you if things don't go as planned.

That works! For the surgery, it depends on the person. Over two years after my first operation and a year after the revision (really? That long already? Wow that time went quick), I'm down to needing to cath for half a day about once every 4-6 weeks. If that's the "cost" to maintain my complete and total urinary incontinence, then I am *so* happy to pay it. While long-term stent use will more lead to urge incontinence from shrinking your bladder over time, it *is* possible to stretch those muscles out with long-term catheter use, slowly increasing to larger sizes. The end result is the muscles not being able to close properly just from how stretched they are. But even then, you'd need to put in a 'maintenance" cath every once in a while to keep things stretched out. End of the day? Our bodies, frustratingly, really want us to be continent, and they have a lot of ways to try to help that, it seems. But as long as you accept the two major risks of stents (damaging something during insertion/retrieval in the urethra, and stent migration requiring an ER visit), they're a pretty solid choice for sometimes-but-not-always incontinence, with proper hygine.

No, but I was in talks to do so. I’ve been hypnotized to have a phobia of the potty, so my options on where to “go” for that are still rather limited, and that’s enough for me at the moment. Maybe some day later, though. No need to rush through things. I’m happy where I am right now.

I wish everyone the best of luck trying to go down this path - I've found it to be a very interesting path to try a lot of these other things people are suggesting. It's hard to find someone who has the credentials AND is willing to do what needs to be done. Things like Botox don't work often enough because practitioners aren't willing to put in enough of the Botox to cause significant effects in a continent individual. Long-term stents come with their own laundry list of problems that most urologists won't be willing to consider without a lot of other issues. Funnily enough, the clinic I went through used nerve ablation for bowel incontinence, though currently they're trying to find another practitioner with the qualifications to merit recommending them for service. It's surprisingly hard to find a way to make a continent person incontinent without significant effort - and if you find anything, please let me know. I'm always eager to hear what other avenues others have found.

The most important thing? Be honest. Embarrassingly honest. Leave NO question what you want and why you want it. Don't fake a medical history, and don't try to use language to hide it. You want a doctor willing to do it, and not afraid to talk about it.

I admit, I'm kind of worried at this point - I do genuinely hope everything has gone well for them, but I'd love to know whether or not they're doing alright.

A totally fair question, and one you phrased perfectly. I admit some fascination at the idea of no longer getting hard, but I didn't want to be impotent as a result of surgery. But like all operations, it was about measuring risks versus rewards. If I couldn't get hard but was incontinent, would that be, on the whole, better? For me, the answer was simple. There would be many ways to explore my sexuality besides an erection. But I had exhausted so many other options for being incontinent. And I ended up being right - the fulfillment of incontinence in my life is better than any momentary climax. But I was lucky - I get to have both still.

This is, I think, at the root of the original question in this topic. You did an better job than I laying out why the desire to leak something out of our genitals and the desire to have perfect control of what comes out of that same place are at odds with each other, and how there may be a much more pervasive desire at play here - the absolution of guilt. But that's not what they want to hear. And when someone tells them it, they start getting...less than coherent in response. Both urologists who operated on me asked the same question, as they consulted me on whether or not to get the surgery, even the external sphincterotomy: "If you leaked urine but couldn't get hard or orgasm again, would you be okay?" For me, the answer was yes. I think I suspect the OP's answer here, even if it might affect how they'd get what they want.

All very good points - and all reasons I made sure to talk with a lot of people before going through with it, including multiple therapists. With any permanent decision, ensuring you're doing it the right way is important. I'd add only one point - if you read through that list and instead of thinking, "Yeah, that sounds terrible," you thought "Yeah, the inconveniences like that are the point," incontinence may be more tied to your happiness than you think.

You know what? If you want to see what me actually attacking looks like, I'm happy to oblige. I was trying very much to avoid such things, but if you need to see it to know the difference between what I said and that, far be it from me to stop you... It wasn't this - wow, what a surprise! When I said "almost nothing," I wasn't exaggerating. The only effect was that, once I started peeing, I couldn't stop it. I had full control of when I peed, I had zero dribbling outside of that. And in three months, even that reverted to normal. I welcome you to actually look at the scientific literature for external urethral sphincterotomies - that's the term you're looking for, and you'll need to do more than just looking at the first two Google results to get at the data, but those rates I quote come from meta-studies of tracking the procedures over five-to-ten year time spans. About 30% of the time, nothing happens - not even what I got. About another 30-40% of the time, *something* happens, similar to what I had, but it goes away quickly. And in the last 20-30%, you get an effect that usually goes away within five years. The urinary system is excellent at repairing itself from such damage - which makes sense, given how important it is for the majority of people to not piss themselves. It's why I discourage people from seeing it as a panacea. I did too, before I did a bunch of research and got one myself. And the person least surprised by my lack of results was the urologist who did the procedure on me. I know it's not what you want. I get it. This is, in fact, the very crux of my point. If this is your guiding principle for seeking incontinence using surgical interventions, it's going to be a problem. It's really that simple. Any procedure that could cause incontinence has this as a side effect right out of the gate, *including* sphincterotomies. If this is your hard line that can't be crossed, I'd highly recommend finding other methods that don't involve physical or surgical interventions. Maybe options exist here, but I've yet to find any that I'd consider safe or sane. But I'm *always* happy to be proven wrong, if you can find evidence to support it. Not theories or google searches - evidence. I could speak to this, but I'd likely swear, and I'd rather not. Let's just say it's hilarious to me that you blame me of attacking, and not only personally attack me, but make wildly accusatory assumptions of my motivations. I'd claim it would be a sign that you are almost certainly not in the right mental headspace to be considering such things, but unlike you, I know I don't know enough about someone I've only met on an internet forum to make such a claim. So I'll instead say it impugns the character of your writing and makes me wonder if there is more at play here. Reddy's story is his to tell, and I know more than a lot of others about the details. I will only say that there is more in play with Reddy's account than the radical oversimplification that you present here. I did! It's also, unfortunately, irrelevant. Are there bad doctors out there? Of course there are. But overcorrecting so hard the other way, and assuming you can't trust anything that any doctor says because you default to the idea that they're greedy or have ill intentions, is just as unhelpful. That's where doing research is useful - actual research, looking at the same studies that the doctor are, finding multiple sources to validate your claims, and using the knowledge others can give you to try to find a path forward. ___ I truly do hope you find what you're looking for. I just suspect you're going to be in for a long, rough road on your current path. But as I said before, I'm not going to try to dissuade you from it - not that I suspect I could anyway. Good luck, truly.

@superabsorbantpolymer - That's the thing - it didn't quite end up like that either. But I strongly suspect that's because there isn't a lot of research into "how do we purposely make continent people less continent?"

I'm thinking it's best I write a dedicated post summarizing it, but now that I'm nine months after my revision and almost two years after the first surgery, I wanted to just chime in again to say that I am absolutely, 100% happy with how things are for me now. Besides retrograde ejaculation, there's been almost no effect to my sexual function, and the stricture is now to the point where I only need to cath every 2-3 weeks to keep it from closing up again. All in all, I'd trade those in a heartbeat to be where I am now, a full-time pantswetter with no hope in hell of staying dry without another surgical intervention. For those trying to look at "But what if you just remove part of it" as a solution, let me caution you immediately that down those roads lie madness. If you want to hope you're the lucky 1 in 3 who first has any results from surgery, and then has those results stay for any significant length of time...then go for it. My original external sphincterotomy did almost nothing, and focusing on just the bladder neck and external sphincter was only a partial success. It took all three to get me here, but now that I'm here...I'm thrilled. If there are specific questions, feel free to ask away, but I'm basically happy to get to just...have incontinence be something I get to enjoy for the rest of my life as I deal with everything else.