Wednesday, June 19, 2024

Treatment For Urinary Incontinence After Prostate Surgery

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What If These Treatments Do Not Work

Fixing Urinary Leakage After Prostate Cancer Surgery | Ask A Prostate Expert, Mark Scholz, MD

If these do not work, you may be sent to a urologist for more tests on your bladder and sphincter. These tests will help decide what type of incontinence you have, how well your bladder is working, and what other treatments might be best for you. A urodynamic test and cystoscopy may be done. They are both done in the office, often during the same visit. The results help decide which procedure might be best for you.

  • The urodynamics test places a very small catheter in your bladder, fills it with fluid, and measures bladder activity and pressure during filling and voiding . You will also be asked to cough and strain so your provider can see if and how easily you leak urine.
  • A cystoscopy may also be done to look at the urethra, the anastomosis , and the bladder. After these tests, your provider will go over the results with you, and together you can decide what treatment would be best.

Alternatives Such As Surgery Injections And Devices

It is rare for men to have long-term incontinence after removal of the prostate. But, if this occurs, there are a range of treatment options available. For men with this issue, its always best to thoroughly discuss this with their doctor to decide the best option.

Surgery is one option for men to consider. Surgeries can restore urinary control in patients with long-term urinary incontinence that lasted more than one year. One type involves placing a rubber ring around the bladders tip to prevent urine leakage.

A short-term relief option is collagen injections. Men who choose this option will get a series of collagen injections helping improve urine control by plumping the urinary sphincter.

Another device that may help could be an artificial sphincter. This patient-controlled device has three parts: a pump, a pressure-regulating balloon, and a cuff that encircles the urethra and prevents urine from leaking. The device can either cure or significantly improve more than 70% to 80% of patients. Another device is a bulbourethral sling. The slings purpose is to suspend and compress the urethra. Using the patients tissue or synthetic material, this device suspends and compresses the urethra helping achieve bladder control.

Types Of Incontinence After Prostatectomy

There are different types and stages of incontinence after prostatectomy. The degree of incontinence can range from a small dribble to a complete lack of bladder control. The incontinence tends to worsen right after surgery and gets better with time.

Types of incontinence after prostatectomy are:

  • Stress incontinence, whichmeans leaking urine when you sneeze, cough, or exercise. Its the most common type of incontinence after prostate surgery. This is because a prostatectomy may damage the muscles and nerves that keep urine in the bladder.
  • Urge incontinenceis a sudden gotta go feeling. Urge incontinence happens when the bladder muscles squeeze without warning, allowing urine to escape. Its more common in men whove had radiation treatment instead of surgery for prostate cancer.
  • Overflow incontinence is when you have trouble emptying your bladder, or your urine comes out in a slow, dribbling stream. It can happen after prostatectomy if scar tissue blocks or narrows the outlet from the bladder.
  • Continuous incontinence is when you lose all control over your bladder. Its rare for it to happen after a prostatectomy.

Most men recover bladder control within six months to a year after prostatectomy. If you are still having problems more than a year after surgery, you may need additional treatment.

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What If The Incontinence Does Not Get Better

In these cases, you should see an incontinence provider to talk about available treatments. They will ask you questions about your health history, the symptoms you are having, the number of pads you use, and what treatments you have already had. They will also do an exam and may ask for a urine sample. They may do a bladder scan to see how much urine is in your bladder.

The incontinence specialist will likely talk about conservative treatments at first. More pelvic floor exercises might be recommended. You may also be given a biofeedback machine that allows you to see how strong your pelvic floor muscles are. The specialist may talk about medication options.

What A Prostatectomy Entails

Robotic Radical Prostatectomy

A prostatectomy is the partial or full removal of the prostate gland. It is a common treatment for prostate cancer that hasnt spread outside the prostate. Men with benign prostatic hyperplasia, a non-cancerous enlarged prostate, may also have this surgery.

The prostate sits just below the bladder. The urethra the tube that carries urine out of the body runs directly through the prostate. Pressure from the prostate helps hold urine in the bladder.

The result is a lack of control over urine flow, or incontinence. In general, older men have more problems than younger men with incontinence after prostatectomy.

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Urinary Incontinence In Men May Be Categorized Into 4 Main Types But Only 2 Of Them Are Due To Prostate Surgery:

1. Stress incontinence

Stress urinary incontinence has to do with higher abdominal pressure. This is also called activity-related incontinence. It can happen when there is sudden pressure from a cough, sneeze, laugh, or exercise.

2. Urge incontinence

Urge incontinence is more frequent in old age where the capability to hold the urine after the urge is felt is gone to some degree. There is a sudden uncontrollable leakage of urine while feeling the urge to urinate.

Known as overactive bladder, urge incontinence followed by bladder contractions is featured by the need to go to the bathroom often and a sudden and serious urge to urinate followed by an uncontrollable leakage of urine. People often do not reach the bathroom.

3. Overflow incontinence

Overflow incontinence is the least frequent, where the bladder becomes full and begins leaking. There is a consistent dribbling of urine even after completing urination.

There is a failure to entirely empty the bladder. Termed chronic urinary retention, overflow incontinence happens when urine is retained in the bladder. Patients who have overflow incontinence may not feel the need to urinate and do not empty their bladders totally. Urine flow may be weak.

4. Functional incontinence

Cost Of Enlarged Prostate Treatment Without Insurance

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.

At New York Urology Specialists, we offer a flat-fee all-cost-includedRezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.

At New York Urology Specialists, we offer a flat-fee all-cost-includedUrolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.

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The Long Wet Road Back To Normal

Incontinence after radical prostatectomy sucks. But for nearly all men, it goes away. For the very small percentage in whom it doesnt, there is help.

JP Mac is an Emmy award-winning animation writer who worked for Warner Bros. and Disney, and a novelist. He is also very funny.

So, when he wrote a short ebook about his experience with prostate cancer including his diagnosis in 2014 at age 61, the rush to find the right treatment and get it done before his health insurance was going to expire, his laparoscopic-robotic prostatectomy and the complications afterward, and his five-month battle to recover urinary continence after the surgery he could legitimately have written a soap opera, or maybe even a tear-jerker but he didnt.

Instead, his ebook has a title that sounds like 1950s pulp fiction: They Took My Prostate: Cancer, Loss, Hope. Its not Prostate Cancer Lite, and it doesnt minimize what he or anyone else has gone through to get back to normal after radical prostatectomy. Far from it in fact, his short, hopeful essay is a testament to what it takes to recover from this difficult but life-saving surgery: a balanced perspective, a good sense of humor, a great support system, and plain old hard work and persistence.

Heres a message you hardly ever hear about prostate cancer, or any illness, for that matter: Its okay to laugh! That doesnt mean its not scary, and that it doesnt wear you down, or that youre not afraid you wont ever get back to normal.

Risk Of Bias Assessment

Urinary Incontinence after Radical Prostatectomy | Prostate Cancer Staging Guide

The Newcastle Ottawa scale, which evaluates cohort selection, comparability and outcomes assessment, was used for non-randomized controlled trials . The Cochrane risk of bias tool which evaluates random sequence generation, allocation concealment, blinding, and attrition was used for evaluation of RCTs.

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What Causes Incontinence After Prostate Surgery

Urinary incontinence is a potential side effect of prostate removal surgery. The prostate is located just below the bladder and surrounds the urethra. Removing it, or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence.

A Patients Story: Overcoming Incontinence

Christopher Miller* is a real estate agent who is married and has two sons. About five years ago, at age 56, Mr. Miller was diagnosed with prostate cancer. After a great deal of research and consultations with five doctors, Mr. Miller decided to have a radical prostatectomy.

Although he considers the operation a success, in that it has apparently eradicated the cancer, Mr. Miller struggled for almost two years to overcome persistent urinary incontinence. For much of that time, he felt ill-served by the medical community. The story of how he eventually overcame this problem may be helpful to other men in the same situation.

What was going through your mind when you learned you had prostate cancer?

Like anyone else, I was surprised. You never think its going to happen to you. The biggest fear, of course, is that it might be life-threatening. Even though I knew this is generally a disease that takes a long time to grow, I still wondered how much longer I might have to live. So I thought of things like: Is my family provided for? Are my financial affairs in order? Will my children be secure? Will I ever meet my grandchildren?

Of course, I was very concerned about my wife. Wed been married 32 years at that point, and I worried about what impact this would have on her. Shes a very strong and good person, and she remained at my side every moment of the time. And that support proved to be invaluable.

How many physicians did you see before making a treatment decision?

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How Can I Manage Incontinence At Home

Incontinence can be uncomfortable and disruptive. It can cause sleeping problems, make you feel ashamed or angry, or affect your daily life in other ways. In addition to working with your health care team to find the best treatment, there are things you can do at home to help make incontinence better or more comfortable.

  • Limit how much you drink, especially coffee and alcohol. Avoid foods that can irritate the bladder, including dairy products, citrus fruits, sugar, chocolate, soda, tea, and vinegar.

  • Go to the bathroom right before bedtime and any vigorous activity.

  • Wear an absorbent pad inside your underwear or disposable incontinence underwear.

  • Maintain a healthy weight. Extra weight can put pressure on the bladder and muscles that support it.

  • Go to the bathroom regularly each day. Do not wait too long or put off going.

  • Quit smoking. Nicotine can irritate the bladder. It can also make you cough and leak urine.

  • Do Kegel exercises. Ask your health care team about doing Kegel exercises at home. They can make your bladder stronger. To do Kegel exercises, first tighten the muscles you use to stop the flow of urine. Then, relax those muscles. Repeat the exercise several times. During this exercise, relax the muscles in your belly, buttocks, and thigh.

Finally, it can help to find support. Talk with your health care team or join a support group for people with bladder problems. It can help you feel better to know that other people are also dealing with incontinence.

What Are The Different Surgeries For Incontinence

Advance Centre for Urogyenacology

There are three main types of surgery for men who have incontinence after an RP:

  • Urethral bulking procedures are done endoscopically . A material is injected just under the lining of the urethra. This makes the urinary passageway smaller. It is often done as an outpatient procedure, either with or without anesthesia. You can often return to normal activity right away. Your body often reabsorbs the material over time so it needs to be repeated every 9-15 months. The side effects can be bleeding, urinary tract infection, and temporary urinary retention . Rarely, patients may feel that their incontinence is made worse by the procedure.
  • Male perineal sling procedures are done in the operating room under anesthesia. A small incision is made in your perineum . A strip of mesh is placed under the urethra and is used to elevate and slightly press on the urethra. You will be asked to limit your activity for 4-6 weeks after surgery to allow the sling to scar into place so it does not move after the procedure. There is little discomfort or pain after the procedure. Success tends to be best in men with minimal to moderate incontinence . Side effects can be bleeding, skin or mesh infection, pain, erosion into the urethra , inability to urinate , and no improvement in continence.
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    What Is Urinary Incontinence And How Is It Related To Prostate Cancer Surgery

    Urinary incontinence is the loss of the ability to control urination . Urinary incontinence sometimes occurs in men who’ve had surgery for prostate cancer.

    If youve had prostate cancer surgery, you might experience stress incontinence, which means you might leak urine when you cough, sneeze or lift something that is heavy. This happens because of stress or pressure on the bladder. There is also a type of incontinence that is called urge incontinence. When this happens, you are hit with a sudden need to urinate right away and have leakage before you can make it to the bathroom.

    What Kinds Of Surgeries Treat Urinary Incontinence After Your Prostate Is Removed

    There are two types of surgery for urinary incontinence: the urethral sling and the artificial urinary sphincter. Usually, the incontinence needs to last for about one year after the prostatectomy to be sure there is not going to be further improvement before your healthcare provider suggests this type of therapy.

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    What Is An Artificial Urinary Sphincter And How Does It Help With Urinary Incontinence

    An artificial urinary sphincter can help men who have moderate to severe urinary incontinence due to poorly functioning muscle or sphincter valve after prostate cancer surgery.

    The AUS has three parts:

    • An inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
    • A pump that is inserted into the scrotum. It’s completely on the inside and not visible, and the pump controls the opening and closing of the cuff.
    • A small pressure-regulating balloon that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.

    If you have this surgery, youll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When youre done peeing, the cuff automatically closes again on its own.

    The AUS procedure provides a very good and satisfactory result in 90% of cases. Risks are uncommon and include:

    • Failure of the device .
    • Erosion of the cuff into the urethra.

    All of these would require additional surgery.

    Questions To Ask Your Doctor Or Nurse

    Theres help for urinary incontinence after prostate cancer.
    • Is the treatment Im having for prostate cancer likely to cause any urinary problems?
    • What type of urinary problems might I get?
    • What should I do if I cant urinate?
    • Will my urinary problems get better?
    • What treatments are available?
    • What are the risks and side effects of treatments for urinary problems?
    • What can I do to help myself?
    • Where can I get pads and other products?

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    Reasons To Have Prostate Surgery

    One of the most common reasons for having prostate surgery, or a prostatectomy, is to treat prostate cancer.

    According to the American Cancer Society, prostate cancer is the second most common form of cancer in American men, right behind skin cancer. Nearly 174,000 new cases are reported in the United States every year. If the cancer has not yet spread outside of the prostate gland, then surgery will be a great treatment option. Another reason to have prostate surgery is to treat an enlarged prostate.

    As the prostate grows, it may block the flow of urine which can create bladder, urinary tract, and kidney related problems. Removing a part of the prostate can help to solve or prevent these issues.

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    How Can Radiation Therapy After Prostatectomy Affect Incontinence

    Some men need radiation after a prostatectomy. This treats the “prostate bed” . Some normal tissue will receive a low dose of radiation, including the external urinary sphincter. The radiation may irritate the external sphincter, urethra, and bladder during radiation therapy and for a short time after. This can lead to worsening incontinence that often gets better in the weeks to months after radiation. Some men may have more incontinence in the months to years after radiation therapy due to the buildup of scar tissue. This can cause the external sphincter to not open and close as it should.

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