Post-Prostatectomy Recovery

About 40% of men who undergo radical prostatectomy will experience urinary incontinence afterward. The reason is simple: The prostate gland is a key part of the body’s mechanism for regulating urine flow from the bladder into the urethra and out of the body. When we remove the gland, control of urine flow falls to the lower external urinary sphincter, a valve that can struggle to keep up.

There are three types of urinary incontinence:

• Stress urinary incontinence (SUI) – when urine leaks during physical exertion or other activities such as coughing, lifting or bending. This is the most common form in men after a prostatectomy and can range from a few drops to near-continuous flow of urine.
• Urgency urinary incontinence (UUI) – when you feel a strong, sudden urge to urinate. This is usually caused by involuntary bladder spasms and can lead to uncontrollable episodes of incontinence. It is linked to symptoms of overactive bladder such going more than eight times a day or getting up more than once a night to go.
• Mixed urinary incontinence – a combination of SUI and UUI.

To determine the type and severity of your incontinence, we recommend these tests:

• Three-day intake and output voiding log. For three separate days, we have you record all fluid intake and track the time and volume of urine voids, as well as any leakage and what you were doing when they occurred.
• Three-day pad weight test. You collect wet pads for three days in sealed storage bags that you bring into us with a dry pad. We weigh each to estimate your average daily volume of urine loss.
• Urodynamic testing. In the office, we record your bladder and urinary sphincter function to determine the nature and cause of your incontinence and any other bladder symptoms
• Flexible cystoscopy. Using a high-definition fiber optic camera, we visually inspect your bladder, urethral sphincter and urethra for any anatomic abnormalities.

Treatment for urinary incontinence is about 95% effective. Options include:

Medication and behavioral therapy. This is often the first step we suggest for helping you manage symptoms and improve bladder control.

Interventional procedures. We offer all advanced procedures to restore urinary control, including bladder Botox® injections and sacral nerve stimulation.

Surgery. We are trained in such innovative surgical solutions as:

• AdVance XP Male Sling, a strip of soft mesh we place inside your body to support the sphincter muscle and restore bladder control. Most patients are continent immediately after the procedure.
• Artificial urinary sphincter urinary control system, considered the best treatment for male SUI, offers men with the most severe incontinence an effective, durable cure. Through small incisions, we implant a pump in the scrotum, inflatable cuff filled with saline around the urethra and balloon reservoir in the abdomen. The device is designed to mimic a healthy sphincter to control bladder flow. When you need to urinate, squeeze the pump to release fluid from the cuff. When the cuff is empty, urine can flow. The cuff automatically refills, squeezing the urethra closed to restore bladder control.

Erectile dysfunction is a common side effect of prostate cancer treatment. Surgery and radiation therapy in the pelvic area can impair nerve function and blood flow in the penis, which can make it difficult to achieve or maintain an erection. This may happen immediately after treatment or you may notice it gradually over the next few years.

Every man’s situation is different, so you will meet with one of our specialists and determine a personalized approach to restoring your erectile function. This may include:

• Oral medication. Daily medication can improve blood flow to the penis, while others can be taken as needed before sexual stimulation.
• Vacuum erection device (VED). An external device, this promotes blood flow to the penis to help maintain erectile function.
• Penile injections. Medication injections can improve blood flow to the penis for firmer erections.

Penile implants. If all other approaches fail, we can surgically implant a discrete device in the penis to help restore erectile function. There are two types of implants – an inflatable device you can inflate using a pump filled with saline to create an erection and deflate by draining fluid; and semirigid rods that create a permanent positionable erection.