By now you have begun to recuperate from your surgery to remove your prostate cancer. The catheter is out and you have been cured of your cancer, however you are experiencing urinary incontinence, the involuntary loss of urine.
This is a scenario that we see in the office many times after radical surgery. Many patients go into these procedures with false hope and the expectation that immediately after surgery they will regain complete continence.
With the introduction of robotic radical prostatectomy, patients now are experiencing higher rates of urinary continence than prior to the era of robotic surgery. After the catheter is removed, the patient may not have immediate continence, and it may take several months for this to occur. However, the vast majority of patients will spontaneously regain continence and ultimately be extraordinarily happy with the outcome of their surgery. Patients are encouraged to do Kegel exercises, a pelvic floor exercise that will help strengthen the muscles of the pelvic floor, the pubococcygeal muscles. Some patients may benefit from various drugs.
Persistent urinary incontinence can occur in a very small percentage of patients. This type of urinary leakage is known as stress incontinence and it occurs as a result of changes to the urinary sphincter and the surrounding musculature during these surgical procedures. The decreasing rate of incontinence is partly attributable to the improved technique that has occurred with the robotic procedures. Those patients who do not regain their continence can undergo various surgical procedures that will help patients regain their continence.
A male sling is a relatively minor outpatient procedure that is intended for patients who have mild to moderate stress incontinence. A synthetic mesh is inserted through a small incision in the area between the scrotum and the rectum. The sling is positioned through various natural openings in the pelvic bones.
In more advanced cases of stress incontinence, an artificial urinary sphincter may be used. This procedure involves the placement of a synthetic cuff around a similar perineal incision. The cuff is attached to a reservoir that is buried beyond the abdominal wall and a pump mechanism that is buried within the scrotum. When the device is activated (six weeks post-operatively), the cuff squeezes the urethra, urine flow stops, and the patient is continent. By squeezing the pump through the scrotal wall, the cuff open and urine flow occurs.
Both of these procedures can render the incontinent patient continent. Patients who have unacceptable amounts of urinary incontinence need not suffer, and should seek help from their Urologist.