Urinary Incontinence Post Radical Prostatectomy
Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.
Urinary incontinence post radical prostatectomy is a very important issue.
The important thing is to try to minimise the impact of your incontinence by doing a very accurate and precise operation.
A new innovation is to perform a pelvic floor reconstruction2 at the time of surgery, which improves early continence.
Patients are taught pelvic floor exercises prior to surgery, so they are familiar with these exercises, and don’t have to learn them after a surgery, so usually at a week after surgery I start patients on pelvic floor exercises.
They see a continence advisor to make sure that they’re using these properly.
Patients can expect some degree of leakage which is quite variable.
It takes on average about 10 or 12 weeks for this to come good, but can take up to a year in some patients.
If they still have incontinence issues a year following surgery, we can look at additional treatments.
A new, relatively minimally invasive treatment is called an AdVance Sling3.
This is a synthetic sling, usually inserted as a day procedure.
It supports the urethra, and is very good for patients that have minimal incontinence of one to two pads a day.
If patients have more incontinence than this, and is a concern affecting their lifestyle, they can have an artificial sphincter inserted.
This is a synthetic cuff that’s inserted around the urethra, and there’s a pump in between the testes and the scrotum which is not visible.
The patients squeeze this pump, and the cuff that’s around the urethra then deflates as fluid gets taken away from this cuff.
Patients then go and pass urine, and this remains deflated for approximately two minutes, and then auto-inflates and blocks off the urethra.
This procedure is a short, one hour procedure, done through a small two to three centimetre incision.
This device has an approximately 95% success rate4, so patients can be rest assured that even if they have an extreme outcome with surgery, that there is a good treatment that’s available for them, in the form of an artificial sphincter which will give them a very high chance of a successful patient outcome5.
References
1. Pietro Castellan, Simone Ferretti, Giulio Litterio - Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions - Ther Clin Risk Manag. 2023; 19: 43–56 doi: 10.2147/TCRM.S2833052. Jianfeng Cui, Hu Guo, Yan Li, Shouzhen Chen, et al - Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques - Scientific Reports volume 7, Article number: 2737 (2017)
3. Boston Scientific - https://www.bostonscientific.com/en-US/products/slings--suburethral/advance-xp-male-sling-system/features--benefits.html
4. Brian J Linder, Laureano J Rangel, Daniel S Elliott - Evaluating Success Rates After Artificial Urinary Sphincter Placement: A Comparison of Clinical Definitions - Urology . 2018 Mar:113:220-224. doi: 10.1016/j.urology.2017.10.033. Epub 2017 Nov 15.
5. Sender Herschorn - The artificial urinary sphincter is the treatment of choice for post–radical prostatectomy incontinence - Can Urol Assoc J. 2008 Oct; 2(5): 536–539. doi: 10.5489/cuaj.924