From the Guidelines
Removing the prostate can improve urine flow initially, but results vary between patients, and some may experience temporary or long-term urinary issues, including urinary incontinence or urethral strictures that can worsen urine flow. After surgery, many men experience a stronger, less obstructed urine stream because the enlarged prostate tissue that was previously blocking the urethra has been removed 1. However, this improvement isn't guaranteed for everyone. Some men may experience urinary incontinence (difficulty controlling urination) that typically improves within 3-12 months but may persist in some cases 1. Other potential urinary complications include urethral strictures (narrowing of the urethra) which can actually worsen urine flow.
Key Factors Affecting Urinary Function
- Surgical technique
- Surgeon experience
- Age
- Pre-existing urinary function Recovery of urinary function depends on these factors, and it's essential to discuss expectations with your urologist before surgery, as the primary goal of prostate removal is usually cancer treatment rather than improving urinary symptoms, though symptom improvement is often a welcome secondary benefit 1.
Management of Urinary Symptoms
Several treatment options exist for urinary symptoms after prostate cancer surgery, including behavioral and pelvic floor physical therapy referral, anticholinergic medications, and urodynamic testing by a urologist 1. For men with persistent leakage, surgical placement of a male urethral sling or artificial urinary sphincter can greatly reduce and/or eliminate leakage. It's crucial to address urinary symptoms and discuss management options with your primary care clinician or urologist to improve quality of life after prostate removal.
From the Research
Urine Stream After Prostate Removal
- The removal of the prostate, also known as radical prostatectomy, can have varying effects on urine stream and urinary symptoms in men.
- A study published in 2003 2 found that there was a significant increase in flow rate and decrease in International Prostate Symptom Score (IPSS) after radical retropubic prostatectomy, suggesting improved voiding function and urinary symptoms.
- The study reported that before surgery, 38% of men had a flow rate of ≤ 10 mL/s, indicating obstruction, but after surgery, the flow rate increased to a median of 16.8 mL/s at the first review and continued to improve over time.
- Another study published in 2021 3 discussed the management of post-radical prostatectomy urinary incontinence and highlighted the importance of anatomic support and pelvic innervation in the etiology of post-prostatectomy incontinence.
- However, a more recent study published in 2022 4 found that despite advances in surgical techniques and postoperative care, there were no consistent observable improvements in urinary function outcomes, including good urinary function, no incontinence, and social continence, over the past decade.
Factors Affecting Urine Stream
- The etiology of post-prostatectomy incontinence is multifactorial, and factors such as extensive dissection during surgery, damage to the neurovascular bundle, and postoperative fibrosis can have a negative impact on continence status 3.
- Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates 3.
- The development of new therapeutic choices, such as male sling techniques, has provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy 3.
Medical Management of Urinary Symptoms
- Medical management of benign prostatic hyperplasia (BPH) using alpha-blockers and 5-alpha-reductase inhibitors can help alleviate lower urinary tract symptoms and postpone or eliminate the need for surgical intervention 5, 6.
- A study published in 2020 6 found that combination therapy using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors was more effective than monotherapy in improving international prostate symptom score, quality of life, and post-residual urinary flow rate in BPH patients.