What is the effectiveness of Emsella for treating incontinence post prostatectomy?

Emsella is Not Recommended for Post-Prostatectomy Incontinence Based on Current Guidelines

There is no evidence supporting the use of Emsella for treating urinary incontinence after prostatectomy, and standard treatments with proven efficacy should be used instead. 1

Understanding Post-Prostatectomy Incontinence

Urinary incontinence after prostate treatment (IPT) is a common iatrogenic condition affecting quality of life for many men following prostate cancer treatment. According to current guidelines, most men experience incontinence immediately after radical prostatectomy, with gradual improvement over time:

• Most men achieve continence within 12 months after surgery 1
• Incontinence is more common following surgery than radiation therapy 1
• Severity ranges from mild (1-2 pads/day) to severe (5+ pads/day) 1

Evidence-Based Management Approach

First-Line Treatment: Pelvic Floor Muscle Exercises

The AUA/SUFU guidelines strongly recommend pelvic floor muscle exercises (PFME) as the initial intervention:

• PFME should be offered immediately in the post-operative period 1
• PFME improves time-to-achieving continence compared to no intervention 1
• Early continence recovery can occur as early as 3-6 months with PFME 1

Research supports the effectiveness of PFME:

• Studies show that structured PFME programs significantly reduce continence recovery time 2
• Preoperative PFME combined with postoperative continuation shows even better outcomes at 1 and 3 months post-surgery 3, 4

Evaluation Timeline and Surgical Intervention

For patients who don't respond to conservative measures:

• Patients showing no significant improvement after 6 months may be candidates for early surgical intervention 1
• Surgery may be considered as early as 6 months if incontinence is not improving despite conservative therapy 1
• Patients with severe incontinence at 6 months should be offered surgical treatment options 1

Proper Evaluation Before Treatment

Before any treatment, proper assessment is essential:

• History and physical examination to characterize incontinence type and severity 1
• Differentiation between stress urinary incontinence (SUI) and urgency incontinence 1
• Assessment of degree of bother and impact on quality of life 1
• Additional testing such as urodynamics or pad testing may be needed in unclear cases 1

Why Emsella Is Not Recommended

The current AUA/SUFU guidelines on incontinence after prostate treatment (2019, updated 2024) make no mention of Emsella as a treatment option 1. The guidelines comprehensively cover evidence-based approaches including:

1. Conservative management (PFME)
2. Surgical options for persistent cases
3. Management of different types of incontinence

The absence of Emsella from these guidelines indicates insufficient evidence to support its use for post-prostatectomy incontinence. When treating a condition with significant impact on morbidity and quality of life, clinicians should rely on interventions with established efficacy.

Clinical Recommendation

For patients with post-prostatectomy incontinence:

1. Begin with properly instructed pelvic floor muscle exercises immediately after catheter removal
2. Monitor progress over 6-12 months
3. For persistent moderate to severe incontinence at 6 months, consider surgical options per AUA/SUFU guidelines
4. Avoid unproven treatments like Emsella that lack evidence in the current clinical guidelines

This approach aligns with the evidence-based recommendations that prioritize patient outcomes in terms of morbidity, mortality, and quality of life.