Urinary Incontinence after Radical Prostatectomy | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, MD, talks about urinary incontinence that can be a side effect of radical prostatectomy. He covers the treatments that can help to manage this side effect, from medications to surgical intervention.

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0:44 Why surgery causes urinary incontinence. When the surgery is performed, the prostate is removed and sews the ends of the urinary passage together. When the catheter is removed, men will be incontinent for a few weeks or months for control to return. 5-10% of men will remain incontinent permanently after treatment.

1:55 The two types of incontinence. There are two types of incontinence: Stress incontinence, and overt incontinence. Stress incontinence is where men can retain urine except when they jump, laugh, or cough. This occurs in 50% of men after RP. Kegel exercises can help improve stress incontinence. Anticholinergic medications such as Detrol, Enablex, Ditropan, and Myrbetric can help with this problem as well.

3:15 Overt incontinence is when leakage occurs all the time. In unskilled hands, RP can cause this issue in up to 30-40% of men. Going to a center of excellence can reduce this statistic to less than 10%.

3:42 Treatment for overt incontinence. Surgical intervention is typically required. For milder cases, a sling procedure typically can help solve the issue. If you go this route, ensure that your urologist has experience in this area. Artificial sphincters involve the placement of a cuff around the urethra with a control mechanism implanted in the scrotum. When a man needs to relieve himself, the cuff releases pressure on the urethra and allows the flow of urine. This treatment tends to be highly effective for overt incontinence.

5:03 Other urinary side effects. Climacturia, where men ejaculate urine after RP occurs in about 20% of men after surgery, but this side effect is not mentioned very often. Ensure that you discuss this potential side effect with your urologist before your procedure. A urethral stricture can happen when scar tissue develops in the urethral passage after surgery. This scar tissue can cause a blockage. Treatment for stricture can cause incontinence if the scar tissue is damaged from the treatment for stricture. Thankfully, this only occurs in about 2-3% of men after RP.

6:47 Conclusion. RP is the only treatment for prostate cancer that commonly causes urinary incontinence. Often times with equal cure rates as the alternatives.

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  Urethral Cancer