Post-Prostatectomy Urinary Incontinence

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Overview
Diagnosis
Treatment

What is Post-Prostatectomy Urinary Incontinence?

Urinary incontinence is a loss of bladder control. It can be as mild as a small leakage or as severe as a complete inability to hold urine. UI is a common complication of prostatectomy, and it is usually temporary. However, the condition lasts longer than a year in up to 8 percent of men.

Post-Prostatectomy Urinary Incontinence Causes

The loss of bladder control after a prostatectomy is directly related to the surgery. Structures called sphincters hold urine in the body. When you relax these sphincters, urine flows out. Normally, there are two sphincters in the male urinary tract. One sphincter is at the bottom of the bladder; the lower sphincter sits below the prostate, behind the base of the penis. Because the urethra goes through the middle of the prostate, the prostate also holds some pressure on the urethra.

When surgeons remove the prostate, the only sphincter left in the urinary tract is the lowest one, closest to the penis. Because this sphincter is not used to working alone, it may not be strong enough at first to keep urine in the bladder.

Post-Prostatectomy Urinary Incontinence Symptoms

Symptoms of UI in men can range from just a few drops of urine to a complete loss of bladder control. Doctors know that UI may become an issue after a prostatectomy, and they generally advise men to wear incontinence pads to trap urine and keep clothes dry. As you recover from surgery, the amount of leaking urine should go down over time.

Urinary incontinence can be embarrassing. The condition may also affect your sleep, since you may have to go to the bathroom multiple times a night.

Post-Prostatectomy Urinary Incontinence Diagnosis

To diagnose urinary incontinence, your doctor will take your medical history. You should talk about any illnesses, medical conditions, or surgeries you have had, including your prostatectomy. They will also need to know how much fluid you drink, whether you consume caffeine and how much, and any medications you take. Before your appointment, it may be helpful to keep a diary of when you notice any leaks and other urinary habits.

You may need other tests to determine exactly why you are leaking urine. These include:

Ultrasound of the bladder: This ultrasound helps doctors look for any abnormalities of your bladder and kidneys.
Urodynamic testing: This type of testing measures how much urine your bladder can hold, as well as whether your sphincter or muscles are weak.

Post-Prostatectomy Urinary Incontinence Treatment

There are several possible treatments for UI after prostatectomy. Doctors try the simplest treatments first.

Some nonsurgical treatments include:

Bladder training: Training your bladder involves using the restroom at certain times to empty your bladder. Over a period of time, you wait longer before emptying your bladder. This gets your bladder used to holding more urine. Your doctor may also suggest that you limit your fluid or caffeine intake at certain times of the day.
Kegel exercise: This movement strengthens the muscles and sphincters around your bladder. In this exercise, you squeeze the muscle that you would use to stop the flow of urine or stop yourself from passing gas.
Medication: Urinary incontinence after a prostatectomy is usually related to the surgery itself. But, if you are having muscle spasms in your bladder, you may need to take medicine by mouth that reduces these spasms.
Injections: In this procedure, the doctor injects bulking agents such as collagen into the tissues around the urethra. This helps the urethra close when you hold in urine.

Surgical treatments include:

Sling surgery: In this surgery, doctors wrap a piece of material around the urethra to move it into a different position and give it support, taking pressure off the sphincter. This minimally invasive surgery is performed through small openings and has a short recovery time.
Artificial sphincter insertion: This procedure implants an artificial sphincter made up of three parts: an inflatable sphincter, a reservoir, and a pump. Doctors place this device around the urethra and behind the base of the penis, at the bottom of the bladder. It works much like a blood pressure cuff; when it is inflated, it stops the flow of urine. The reservoir, which is placed in the abdomen, contains a small amount of liquid, while the pump sits under the skin of the scrotum. When you need to empty your bladder, you squeeze the pump, which moves the liquid out of the sphincter and into the reservoir. After a few minutes, the liquid that was pumped into the reservoir moves back into the sphincter by the force of gravity.

This surgery can be performed either under general anesthesia or while you are awake using spinal anesthesia. The recovery from this surgery generally lasts only a few days.