From the Guidelines
Urinary leakage after a radical prostatectomy is a common issue that typically improves with time, and I strongly recommend starting pelvic floor exercises (Kegel exercises) immediately to strengthen the muscles that control urination. Performing 3 sets of 10 contractions daily, holding each contraction for 5-10 seconds, can significantly reduce leakage within 3-6 months 1. While waiting for improvement, use absorbent pads to manage leakage and change them regularly to prevent skin irritation. Some key points to consider include:
- Staying well-hydrated but considering limiting fluid intake in the evening to reduce nighttime leakage
- Avoiding caffeine, alcohol, and spicy foods which can irritate the bladder
- Consulting your urologist about additional options such as a urethral sling procedure or artificial urinary sphincter if leakage persists beyond 6-12 months post-surgery Urinary incontinence occurs because the prostatectomy may affect the urinary sphincter and surrounding muscles that control urine flow, and most men experience significant improvement within the first year as tissues heal and pelvic floor strength improves with consistent exercise 1. It's essential to note that the artificial urinary sphincter is preferred over male slings or adjustable balloons for men with stress urinary incontinence after primary, adjuvant, or salvage radiotherapy, and patients should be counseled that the artificial urinary sphincter will likely lose effectiveness over time and reoperations are common 1. Given the limited clinical experience of implanters across the United States, providers should obtain specialty training prior to device implantation, and patients should be counseled accordingly 1.
From the Research
Post-Prostatectomy Urinary Incontinence
- Post-prostatectomy urinary incontinence is a significant issue affecting the quality of life of patients who undergo radical prostatectomy 2, 3, 4, 5.
- The etiology of post-prostatectomy incontinence is multifactorial, including anatomic support, pelvic innervation, and surgical factors such as extensive dissection, damage to the neurovascular bundle, and postoperative fibrosis 2.
Treatment Options
- Conservative approaches, including pelvic floor muscle training (PFMT) and lifestyle changes, are often the first line of treatment for post-prostatectomy urinary incontinence 2, 3, 4, 5.
- Pharmacotherapy, such as duloxetine, may be used to treat overactive bladder, but it can have severe side effects 2.
- Surgical options, including male slings and artificial urinary sphincters, are available for moderate to severe incontinence 3, 4, 5.
- Individualized pelvic physical therapy programs aimed at normalizing pelvic floor function can also be effective in reducing stress urinary incontinence and pelvic pain 6.
Factors Influencing Treatment
- Patient characteristics, lower urinary tract function, and surgical issues can influence the choice of treatment for post-prostatectomy urinary incontinence 5.
- A comprehensive medical history, physical examination, and use of validated questionnaires and voiding diaries can help identify contributing factors and guide treatment decisions 5.