I would like to continue reviewing robotic surgery and its advantages to open prostate surgery. One of the main complications from prostate cancer surgery is urinary incontinence. The sphincter muscle that controls the storage of urine in the bladder can become damaged from surgery. The damage can be mild or severe depending on the extent of cancer, the surgeon’s skills and the patient’s medical condition. I also believe that a man’s age plays an important role in how much they will “leak.” A 50-year-old man usually has better sphincter control than a 70-year-old man.
Over the last two decades, urologists have been able to improve the ability to “spare” the sphincter mechanism during open prostate surgery. However, many men were remaining incontinent (leaking urine) after surgery. All men, let me emphasize that–all men, will leak urine for the first few weeks after surgery. As the man heals from his surgery and gets stronger, the control of urine will return. Kegel exercises, an exercise to squeeze the pelvic muscles, can quicken the return of urinary control. Overall, the urinary incontinence rate at one year after open surgery is well over 90%. That means 10% of men will have some form of leakage one year after surgery.
We are seeing a promising future of urinary incontinence as robotic surgery is becoming the gold standard for the surgical removal of prostate cancer. Robotic surgery is more precise. The urologist can visualize the pelvic organs better and there is less trauma to the pelvic muscles during robotic surgery. This minimizes any injury to the sphincter muscle when removing the prostate gland.
A patient wears a catheter for about seven days after having the prostate removed robotically. This helps the bladder-urethra connection (called the anastomosis) to heal. A man should expect to leak urine when the catheter is removed. I start all my patients on Kegel exercises upon removing the catheter. These exercises should performed ten times per day. In robotic surgery, urologists are having a few men “dry” (no leaking) within a week of removing the catheter. The majority of men are becoming dry within three months of the surgery and the overall continence rate is over 95%. In the future, we can expect new techniques to improve continence after robotic surgery and even decrease the time a man needs to wear a catheter.