Operations for prostate cancer can leave sequelae, among the most frequent of which is urinary incontinence. Dr. Moncada, expert in Urology, determines the different types of incontinence and the most indicated treatments for each one.
Urinary incontinence is the most common sequel after radical prostatectomy, the operation to remove the prostate due to cancer.
What does urinary incontinence consist of?
A patient with urinary incontinence is unable to control the leakage of urine from the bladder and wets involuntarily. Urinary incontinence can be more or less severe depending on the volume of urine that leaks per day, and is usually measured as the number of pads or diapers that have to be used daily. Being incontinent affects not only physically, but also emotionally and socially.
After prostate cancer surgery, normal bladder control should be regained within several weeks to a few months. This recovery occurs gradually once the muscles that control the passage of urine are rehabilitated enough to control urine again.
Who is most likely to experience urinary incontinence?
In general, older or overweight men tend to have more incontinence problems after radical prostatectomy than younger men. Robotic surgery and the surgeon’s experience minimize the possibility of urinary incontinence in most cases, allowing adequate continence in a very short time after surgery.
Types of urinary incontinence
Stress incontinence is the most common type of urinary incontinence after prostate surgery. It occurs when the muscle that contracts the urethra to keep urine in the bladder (the urinary sphincter) is weak or damaged, or when the nerves that help the muscle function have been affected. In this type of incontinence, urine leaks when coughing, laughing, sneezing, lifting heavy objects or exercising. Those with stress incontinence may sleep through the night without having to get up to go to the bathroom, but may leak urine when they wake up in the morning.
Urge incontinence is incontinence caused by involuntary contractions of the bladder. Men with this type of incontinence have a sudden urge to urinate, even though they are not straining. Urge incontinence may be called overactive bladder. If you have urge incontinence you may feel as if you have a weak bladder or cannot hold the fluids you consume, and urine may even leak into your bed while you sleep. This may be caused by a urinary tract infection and also by irritation in patients undergoing radiation therapy.
Sometimes both types of incontinence (urinary urgency and stress incontinence) are associated, being called mixed incontinence.
Treatment for urinary incontinence
Treatment will depend on the type and cause of incontinence and how severe the problem is. There are medications that help the bladder muscle (the detrusor) and the muscles that control urinary flow. These medications called anticholinergics or antimuscarinics work best for urge incontinence. It should be noted that these medications may have side effects such as dry mouth or constipation.
For stress incontinence, initially, rehabilitation of the pelvic floor is indicated through Kegel exercises that help strengthen the pelvic floor muscles. These exercises are easy to learn and require a certain amount of perseverance and patience. In the most severe cases or those that are not corrected in the medium to long term, surgery can be performed to correct the incontinence.
In mild or moderate cases, when 2 or 3 diapers are wet daily, a suburethral sling or incontinence mesh can be used. This simple surgery corrects most of the stress incontinence that can arise after radical prostatectomy.
In cases of severe incontinence (4 or 5 diapers a day) an artificial urinary sphincter is implanted. This is a device that keeps the urethra closed by placing a pressure cuff that the patient manipulates to open it and urinate. The efficacy of the urinary sphincter is very high and patients are very satisfied with this treatment.