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Diseases & Conditions

Urinary Incontinence After Prostate Cancer Surgery

Urinary incontinence is the loss of the ability to control urination. Urinary incontinence sometimes occurs in men who have had surgery for prostate cancer.

What is the prostate’s role in urination?

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The male urinary tract

When urine is emptied into the bladder from the kidneys, it is kept inside the body by a couple of valves that stay closed until you “tell” them to open when you urinate. The prostate gland, which surrounds the urethra (the tube that allows urine to flow outside the body) also helps to hold back urine until given the word to “go.”

Complete removal of the prostate through surgery (radical prostatectomy) can cause urine leakage because it upsets the way the bladder holds urine. Approximately six to eight percent of men who have had surgery to remove their prostate will develop urinary incontinence.

Fortunately, there are ways to treat incontinence that is caused by prostate surgery. For instance, there are medications or behavioral techniques and exercises, including Kegel exercises and biofeedback, that teach men to hold urine.

However, these methods help only a small number of men who have more severe leakage problems. When these treatments fail, the patient may need surgery. There are two types of surgery for urinary incontinence: the urethral sling and the artificial urinary sphincter.

What are the risks and complications of the male sling procedure?

The main risks of the urethral sling procedure include a temporary inability to urinate, or the possibility of urinary leakage reoccurring later.

Complications are rare, and may include bleeding and infection (of the mesh or the bone area or pubic bone), erosion, inability to urinate (very rare) or continuing leakage.

Artificial urinary sphincter

Patients who have moderate to severe urinary incontinence as a result of significant sphincter muscle or valve damage after prostate cancer surgery may need an artificial urinary sphincter (AUS).

The AUS has three parts:

  • an inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
  • a pump that is inserted into the scrotum. The pump controls the opening and closing of the cuff.
  • a small pressure-regulating balloon (about the size of a ping-pong ball) that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to hold urine back.
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Artificial urinary sphincter

When the patient feels the need to urinate, he presses on the pump, which opens the cuff to allow urination. Once the patient is done urinating, the cuff automatically closes again.

The AUS has a success rate of 90%. Although uncommon, risks of the procedure include malfunction of the device (usually due to a fluid leak), erosion of the device into the urethra, and infection. All of these would require additional surgery.

Urethral sling

In the urethral sling procedure, a synthetic (man-made) mesh tape is placed around part of the urethra, which gently and slightly moves the urethra into a new position. This is a minimally invasive procedure, which means that the surgeon only has to make a small incision (cut) in the perineum (the space between the base of the scrotum and the anus).

A urethral sling procedure is best suited for men who have mild to moderate urinary incontinence after a radical prostatectomy. It is highly successful in helping patients overcome incontinence, or reduce episodes of leaking urine.

Before the surgery, the doctor may do some tests, including the following:

  • a urodynamic study, to test how well the urinary tract is working;
  • a 24-hour pad test (to identify how many pads the man uses and how much urine he leaks);
  • a cystoscopy, a test in which the doctor looks inside the bladder with an instrument called a cytoscope.

The patient does not have to donate any of his own blood before surgery.

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(Figure: In the male urethral sling procedure, synthetic mesh-like surgical tape is placed around part of the urethral bulb, slightly pressing down on the urethra and moving it into a new position.)

What happens after surgery?

There is often swelling after surgery that makes it difficult to urinate. The patient may have a catheter (a hollow tube) coming out of the urethra for a short period of time to allow him to empty his bladder.

After the swelling goes down, the patient will gradually be able to urinate on his own and empty his bladder well. However, the normal urination pattern may not return for a few weeks.

Patients usually recover from this surgery quickly. It’s best to limit rigorous activities for approximately six weeks after surgery to avoid having the sling come down before healing is complete.

Some patients undergoing the procedure have been cured of their urinary incontinence; others have improved to the point where they don’t use as many pads.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/12/2012...#8096