From the Guidelines
Urinary frequency after prostate surgery can be effectively managed through a combination of behavioral techniques, pelvic floor exercises, and medications, with most patients seeing improvement within 3-6 months after surgery as the bladder and urethral sphincter heal. The management of urinary frequency should prioritize reducing morbidity, mortality, and improving quality of life. According to the American Urological Association (AUA) guidelines 1, patients should be informed about the risk of incontinence after prostate treatment and the potential benefits of conservative management.
Behavioral Techniques
Some key behavioral techniques include:
- Timed voiding, where patients urinate on a schedule rather than waiting until urgency develops
- Limiting fluid intake in the evening
- Avoiding bladder irritants like caffeine, alcohol, and spicy foods
Pelvic Floor Exercises
Pelvic floor exercises, such as Kegel exercises, can help strengthen urinary control by contracting the pelvic floor muscles for 5 seconds, then relaxing for 5 seconds, repeating 10-15 times, three times daily.
Medication Options
Medication options, such as anticholinergics (e.g., oxybutynin 5mg twice daily or tolterodine 2mg twice daily) and mirabegron (25-50mg daily), can reduce bladder overactivity and improve symptoms. These medications typically require 2-4 weeks for full effect.
Additional Considerations
Bladder retraining by gradually increasing the time between voids can also help improve urinary frequency. If symptoms persist beyond 6-12 months, patients should consult their urologist for additional treatment options, including surgical management if necessary 1. The AUA guidelines recommend that patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence be offered treatment options per the AUA Overactive Bladder guideline 1.
Surgical Management
Surgical management, such as artificial urinary sphincter (AUS) placement, may be considered for patients with persistent stress urinary incontinence after prostate treatment, particularly if conservative measures fail 1. However, patients should be counseled about the potential risks and benefits of surgical management, including the possibility of device failure and the need for reoperation.
Overall, a comprehensive approach to managing urinary frequency after prostate surgery should prioritize patient education, behavioral techniques, pelvic floor exercises, and medication options, with surgical management considered for patients who do not respond to conservative measures.
From the FDA Drug Label
Trospium Chloride Extended-Release Capsules were evaluated for the treatment of patients with overactive bladder who had symptoms of urinary frequency, urgency and urge urinary incontinence in two 12-week, randomized, double-blind, placebo-controlled studies The co-primary endpoints in the trials were the mean change from baseline to Week 12 in number of voids/24 hours (reductions in urinary frequency) and the mean change from baseline to Week 12 in number of incontinence episodes/24 hours Trospium Chloride Extended-Release Capsules demonstrated statistically significantly (p<0. 01) greater reductions in the urinary frequency and incontinence episodes, and increases in void volume when compared to placebo starting at Week 1 and maintained through Weeks 4 and 12
Treating urinary frequency after prostate surgery can be done with Trospium Chloride Extended-Release Capsules, as it has been shown to reduce urinary frequency in patients with overactive bladder.
- The studies included patients with symptoms of urinary frequency, urgency, and urge urinary incontinence.
- The results showed statistically significant reductions in urinary frequency and incontinence episodes, and increases in void volume compared to placebo.
- However, it is essential to note that the studies did not specifically focus on patients who had undergone prostate surgery, so the results may not be directly applicable to this population 2.
From the Research
Treatment Options for Urinary Frequency after Prostate Surgery
- Urinary incontinence is a common symptom after prostate surgery, and it can be managed with conservative treatment, including pelvic floor muscle training (PFMT) 3, 4, 5.
- PFMT has been shown to improve continence in men after prostatectomy, and it is recommended as a first-line treatment for urinary incontinence 3, 6.
- Behavioral therapy combined with medication can also improve symptoms of nocturia, which is often associated with urinary frequency 3.
- Lifestyle changes, such as weight loss and dietary modification, can also help alleviate symptoms of urinary frequency and incontinence 3.
Pelvic Floor Muscle Training (PFMT)
- PFMT involves exercises that strengthen the muscles of the pelvic floor, which can help improve bladder control and reduce urinary frequency 4, 5.
- Studies have shown that PFMT can be effective in improving continence in men after prostatectomy, and it can be started before or after surgery 3, 6.
- The exercises can be tailored to the individual's needs and can be performed with or without the help of a healthcare professional 5.
Other Treatment Options
- Other treatment options for urinary frequency after prostate surgery include surgical interventions, such as the artificial urinary sphincter (AUS) and male urethral sling 7.
- These options are typically considered for men who have not responded to conservative treatment or who have more severe symptoms of incontinence 7.
- Patient education and implementation of pelvic therapy, as well as modern surgical techniques, have greatly improved continence results in men after prostate surgery 7.