What Is Post-prostatectomy Incontinence?
As the name suggests, post-prostatectomy incontinence is characterized by urine leakage after prostatectomy or prostate removal surgery. It is a condition wherein the patients lose their ability to control the urine flow. It is commonly observed in males who have undergone prostate surgery previously. Patients who have undergone prostatectomy are more prone to stress urinary incontinence, which implies that they tend to leak urine during coughing, sneezing, or lifting something heavy. This usually occurs due to pressure on the urinary bladder. Post-prostatectomy patients are also at risk of developing urge incontinence, meaning they will have a strong urge to urinate or pass urine even before reaching the bathroom.
How Does the Prostate Gland Influence Urination?
The prostate gland is an essential part of the male genital tract. Usually, the urine reaches the urinary bladder through the tubes known as the ureters. The urinary bladder is well connected to the prostate gland. A couple of valves, known as the sphincters, are at the junction of the urinary bladder and the urethra. These valves open and close periodically to regulate the urine flow. Radical prostatectomy is a procedure wherein the prostate gland is surgically removed from the patient’s body. Sometimes, the surgeon has to remove the valves outside the prostate gland that regulate urine flow. Normally, the patient can survive with one valve, but the nerves and muscles around the area might get damaged after prostatectomy resulting in urine leakage. Studies report that 6 to 8 % of the males who have undergone prostate removal surgery tend to develop urinary incontinence.
Will Urinary Incontinence Last Long After Prostate Surgery?
Nothing can be predicted about the exact duration of urinary incontinence. This is because several factors influence the chances of urinary incontinence, including age, weight, and physical characteristics of the urethra. Some males do not face this problem and can hold urine after the procedure. Sometimes, they use diapers or pads for three to four months to overcome this problem. This fact is true for males in the age range of 40 to 60 years who are healthy. However, patients having persistent problems can consult their doctor.
How Can One Manage Urinary Incontinence After Prostate Surgery?
The management of urinary incontinence after prostate surgery depends upon its severity. For example, patients with mild or moderate incontinence can initiate non-invasive treatment methods like medications and pelvic floor muscle exercises. These methods do not directly treat urinary incontinence but reduce the number of times the patient has to urinate at night. However, males with severe problems or persistent urine leakage might not benefit from non-surgical methods and require surgical intervention soon.
Which Surgeries Can Be Done to Treat Urinary Incontinence After Prostate Surgery?
Usually, two types of surgeries are done for post-prostatectomy incontinence, sling surgery, and the artificial urinary sphincter. However, not all patients are considered eligible for incontinence surgeries. Only the ones who have had persistent incontinence for more than a year are advised of surgery. The two types of surgery are explained below:
Urethral Sling Procedure - It is a procedure wherein a mesh tape is placed around a part of the urethra to place the urethra in a new position. It is a minimally invasive procedure as the surgeon has to make minor incisions in the perineum (the area between the anus and the scrotum). The doctor recommends this procedure to patients with mild or moderate urinary incontinence after the radical prostatectomy that has not improved even after using other nonsurgical procedures. Hence, the urethral sling procedure is beneficial in reducing episodes of urinary incontinence. Before the procedure, the doctor might recommend the following tests:
A urodynamic study to assess the bladder condition.
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A pad test calculates the number of pads used by the patient during the 24 hours.
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Cystoscopy can also be done to detect urologic abnormalities.
Artificial Urinary Sphincter - It is a device that helps men with severe incontinence and poorly functioning sphincter valves after prostatectomy. The three parts of an artificial urinary sphincter are listed below:
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An inflatable cuff is positioned near the urethra. It acts as a barrier for the urethra and prevents urine leakage.
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It has a pump that lies in the scrotum. However, the pump remains concealed and regulates the opening and closing of the cuff.
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A small balloon is placed under the abdominal muscles. It helps maintain the pressure in the urethral cuff.
Patients undergoing this procedure need to press the pump when they wish to pass urine which opens the cuff and allows one to pass urine. When the patient urinates, the cuff closes automatically. The artificial urinary sphincter provides excellent results. Some of the risks of artificial urinary sphincter surgery are listed below:
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The device might fail due to a fluid leak.
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Erosion of the cuff.
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Infections.
What Happens After the Surgery?
Some patients might find it difficult to urinate after the urethral sling procedure. Surgery complications typically include bleeding, infections, erosion, and continuous leakage. Though the surgery has complications, patients recover from it quickly. However, it would be better if the patient refrains from doing any physical activities for six weeks. This is because the sling might loosen even before the healing is complete. Some patients might have swelling in the area after the surgery and face difficulty passing urine. A tube known as the catheter might hang from the urethra for a few days after the procedure. The catheter will be removed after three days. Normally, the patients start urinating during this time span. Under rare circumstances, the doctor might reinsert the catheter. The patient will begin urinating normally once the swelling subsides. However, one must not get anxious as it takes time for the regular urination pattern to get restored. The good thing about the procedure is that most patients have overcome their problems and stopped using pads. Some patients have observed a reduction in the number of pads that they used previously.
Conclusion:
Post-prostatectomy incontinence is a term used to describe urine leakage after prostate surgery. Though the condition is common, it should not be ignored, as continuous urine leakage can give rise to several urologic diseases. Patients with mild incontinence can opt for non-surgical measures. However, surgical intervention is required for the ones with severe symptoms. Consulting a urologist to know more about the management of post-prostatectomy incontinence may improve the lifespan and reduce complications of the patient.
