Returning to Continence After Radical Prostatectomy

When a prostatectomy or removal of the prostate is indicated for prostate cancer, many men are concerned about their urinary function and long-term leakage because of their procedure. All men will experience some form of leakage initially after their prostatectomy, but most men will eventually regain their urine control.

Two Valve Structures Become One

Before discussing progress toward regaining continence, it's important to explore why a radical prostatectomy causes incontinence in men. Men essentially have two urinary valves: the external urinary sphincter and pelvic floor muscles, specifically designed to hold urine back, and the internal urinary sphincter within the prostate itself. Both structures help slow the flow of urine and prevent urine leakage when engaged and functioning normally. However, when the prostate is removed, more pressure is placed on the external urinary sphincter, and it simply may not be up to the task…for now. Each of us has varying strengths of the pelvic floor muscles. In the immediate aftermath of surgery, they must (and most often will) adapt to not having the additional resistance from the prostate.

During this time, men may leak very little, maybe only wetting one pad daily. For some, however, this leakage may be far more significant and cause them to wet several pads daily. Unfortunately, there is no way to know precisely how many pads, how much leakage will occur, and how quickly continence will be restored.

About 90-95% of patients will ultimately regain continence after the first year to 18 months after their prostatectomy.

Regaining Continence Sooner

The patient's lifestyle and dedication to recovery will make a difference in the return to continence.

Lifestyle changes

Patients should avoid smoking, drinking, and any other activity that may irritate the urinary tract or affect musculature, either in the urinary system or systemically. Losing weight through improved diet and exercise can also help.

Kegels

The patient will also be counseled on using Kegel exercises to improve pelvic musculature and speed up recovery. Dedicating oneself to these exercises can make a significant difference.

Keep normal urinary function

Do not try manipulating urinary function by holding urine for long periods or limiting fluid intake. Instead, eat and drink normally and as healthily as possible to offer the best chance of regaining continence without urinary dysfunction.

Dr. Kemper, a men's health specialist and continence restoration expert at Georgia Urology, offers one of his most important pieces of advice that every patient should follow: "Do not get discouraged if progress towards continence is slow. This is generally expected; even small improvements and milestones should be celebrated."

Below, we will talk about those milestones for most patients.

As your urinary system and urinary sphincter adapt to the new reality without a prostate, the initial feeling and sensation may be of a significant or even complete loss of urinary control, which can be very distressing. For some, this may last just a few days, while for others, it may be weeks or months before they urinate. For a small minority, continence does not return, and we will discuss options for that eventuality below. Be sure to use change pads frequently, and while you may have to modify your social engagements, do so knowing that this is likely temporary.

• The first step is getting through the night. You might find your pad dry overnight, but you may not have enough time to get to the bathroom once you wake up.
• Next, after waking up, you may be able to hold your urine until you get to the bathroom. This is a significant step that shows adaptation and progress.
• From there, after waking up, you may find that you can hold your urine until midday or so until your musculature tires.
• In the fourth stage, you may be able to hold your urine until late in the afternoon, and you leak just a bit.
• Finally, you are likely to reach the stage where you only need a pad for significant exertion, sneezes, coughs, or emergencies when there's no bathroom nearby.

These are all huge milestones that tell you you're getting close. However, progress may not be linear, and there's no way we can put a timeline on it. You may find that progress stops and starts, and one month may yield significant improvement while the next will be slow and frustrating.

Eventually, you will reach a point where you are down to a single pad but never wetting it. We call this the security pad, and you may feel compelled to wear it just in case. However, at this point, we always recommend patients take the plunge and go pad-free if only for their psychological well-being.

Continued Incontinence

For the 5-10% of men who do not regain full continence, there are two effective options, and patients do not need to live with incontinence for the rest of their lives.

1. Male Urethral Sling - A small hammock-shaped mesh sling that lifts the urethra and bladder neck and allows for better urine management. This is typically used for milder cases of stress urinary incontinence that don't respond to lifestyle changes and Kegels.
2. Artificial Urinary Sphincter-This device is implanted around the urethra and is manually activated using a pump in the scrotum to release pressure on the urethra, allowing you to urinate.

The Bottom Line

Work with your Georgia Urology specialist to develop a plan to return to continence as quickly as possible. With our help and guidance, we can get past urinary incontinence together. You can schedule an appointment online to speak to one of our urologists for more information.

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