Why do men leak urine after prostate surgery?

10:30 AM “It occurs because part of the continence mechanism may have to be removed to treat the prostate cancer.” McCormick says it can leave the patient with something called stress incontinence.

healthcare.utah.edu - Treating Urinary Incontinence After Prostate Surgery

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Nov 19, 2021 10:30 AM

Up to 10 percent of men will experience some degree of urinary incontinence (involuntary leakage of urine) after prostate cancer surgery, says Benjamin McCormick, a University of Utah Health surgeon specializing in reconstructive urology. “It occurs because part of the continence mechanism may have to be removed to treat the prostate cancer.” McCormick says it can leave the patient with something called stress incontinence.

“Under the umbrella of incontinence, there are three main types,” says McCormick.

Stress incontinence, which is urine leakage associated with activity

Overflow incontinence, where the bladder is full but there’s no sensation, so it spills over

Urge incontinence, also known as an overactive bladder

Stress Incontinence Surgery

“There is no bladder control medication to treat stress incontinence,” says McCormick. “But there are medications for urge incontinence, so if there's a component of urgency, you can try those medications first.” Otherwise, McCormick notes, there are two main surgical treatments available to men for stress incontinence treatment: Urethral Sling – “This is not bladder lifting surgery, rather it’s a sling placed around the urethra to lift it back into a normal position and apply pressure for better urine retention.” Artificial Sphincter – “A fluid-filled cuff wraps around the urethra to keep urine from leaking out, until you squeeze the scrotal pump to open the cuff.” McCormick says both urinary incontinence surgery methods are outpatient or same-day procedures. They differ in that the sling provides immediate improvement in incontinence, while artificial urinary sphincter (AUS) surgery can treat more severe incontinence, but is activated after healing occurs. “There’s an activation button on the pump placed in the scrotum that we gently press at about six weeks.” Each bladder leakage surgery methods can make a significant difference. “They are both highly successful in reducing the amount of incontinence. Up to 85-90% effective in curing or greatly improving incontinence.”

Candidates for Surgery

“The sling procedure would be for someone with mild incontinence, maybe using one to three pads per day to deal with leakage,” says McCormick. “More than that, and you'd start to think about using an AUS, which is best for moderate to severe incontinence.” McCormick says the procedures can really make an impact. “Going from soaking maybe five to ten pads a day to only using one pad and getting back out there to play golf again or do whatever you enjoy - there can be such a huge quality of life improvement for patients.” Regardless of method, McCormick says urinary incontinence treatment for elderly patients is the same as for those who are middle-aged.

Over the Counter for Bladder Control

So, what’s available to men OTC for bladder control?

“For incontinence care at home, there's a device called a Cunningham Clamp that can be used very temporarily,” says McCormick. “It's just a soft clip that stays on the penis and can help hold back urine.” The user decides when to remove it, to relieve themselves. The bladder is supported by pelvic floor muscles, so in some patients stress incontinence can be improved by simple light pelvic exercises to restore flexibility and muscle strength. McCormick says It’s also helpful to drink enough water and avoid caffeine and alcohol.

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Are you awake during a TURP?

The type of anaesthetic used may be either: a general anaesthetic – this means you'll be unconscious throughout the procedure. a spinal or epidural anaesthetic – this means you'll be awake during the procedure but won't be able to feel anything below your waist.

nhs.uk - Transurethral resection of the prostate (TURP) - How it's performed - NHS

A transurethral resection of the prostate (TURP) is carried out in hospital under anaesthetic. You'll usually need to stay in hospital for 1 to 3 days.

Preparing for surgery

You'll usually be asked to attend a pre-admission appointment a few weeks before your operation so a doctor or nurse can make sure the operation is suitable for you and that you're well enough to have an anaesthetic. This may involve tests such as blood tests and an electrocardiogram (ECG) to check your general health. An ECG is a simple test to check the electrical activity of your heart. You can also use this appointment as an opportunity to ask any questions about the procedure and discuss any concerns you have. Make sure you tell your doctor or nurse if you're currently taking medication to prevent blood clots, such as warfarin, rivaroxaban, aspirin or clopidogrel. These medications could cause heavy bleeding during surgery, so you may be advised to stop taking them in the lead-up to your operation. If you smoke, you should try to cut down or give up completely before your operation, as this can help reduce your risk of potentially serious complications such as chest infections and blood clots.