Incontinence after Prostate Cancer

About 10% of men after prostate cancer suffer with incontinence on an ongoing basis. It is a serious problem that men are often reluctant to discuss with others.

When the muscle (sphincter) that holds the bladder outlet closed is not strong enough to retain urine in the bladder, as is often the case if the sphincter or nerves going to it have been damaged by the prostate cancer surgery. or if there are abnormalities of bladder function, the result is urinary incontinence.

Incontinence after prostate cancer treatment may occur when:

  • The sphincter is too weak (most common problem)
  • The bladder muscles contract too strongly

THE TYPES OF INCONTINENCE

Stress Incontinence: Is the accidental release of urine when pressure is applied to the bladder, such as when you cough, sneeze, laugh or lift something heavy. This is the most common type of incontinence post-prostate cancer.

Urge Incontinence: Is when the bladder contracts at the wrong time giving you the feeling that you have to urinate immediately even if you may have just emptied your bladder.

Overflow Incontinence: Is characterised by leaking when the bladder does not empty properly. This can be due to other medical conditions such as an enlarged prostate or a narrowing of the urethra.

Total Incontinence: Is continual leakage of urine due to complete sphincter deficiency.

HOW IS INCONTINENCE TREATED?

Proper treatment can help you return to a more natural lifestyle.

  • Regain dignity
  • Resume intimacy
  • Save money on protective garments

The type of incontinence that you are diagnosed with will determine your treatment options. Some options available are:

  • Behavioural modification or Medication, but after prostate cancer treatment, the incontinence will usually require surgery

SURGICAL TREATMENT

Once an accurate diagnosis is made by your Dr. Love, particularly an understanding of the amount and type of incontinence,, it may be determined that the best way to treat your incontinence is to have a bulbourethral sling implanted, this device being surgically placed under the urethra (water-tube) to elongate and support it.

The sling is made of a polypropylene mesh material, which is implanted underneath the bulbous urethra to elevate and apply a gentle compression to prevent urine leakage.

There are a variety of slings available, and all are similar but also have differences in the way they work, making some more suitable than others in different men.

One such sling is the Virtue® Male Sling (Coloplast ).

Typically, Virtue® is inserted during a small operative procedure involving one night in hospital. Individual recovery time may vary, but the average time is 4-6 weeks. During this time, heavy lifting should be avoided. Your urologist will discuss your recovery plan in greater detail.

Another useful sling is the ATOMS ® adjustable sphincter, combining a sling and an injection port for further adjustment of the sling (if required) in the office as an outpatient.

Virtue® and other slings, like ATOMS ®, should offer a permanent solution.

Once the sling is in place, you can enjoy the active lifestyle you had before, playing sports, exercising, dancing and just carrying in the groceries without fear of leaking.

For men with more significant incontinence a different style sling, the ATOMS® , is used. This sling can be adjusted later in the office, so will cope with larger amounts of leakage.,

For men with very severe, even at rest, leakage, or who have complex bladder reconstruction surgery, an artificial urinary sphincter may be required.

This device is also implanted surgically around the urethra, but applies constant pressure and needs to be opened by a scrotal pump when a patient wants to pass urine. It will solve even severe incontinence.

Dr. Love has extensive experience in all the surgical treatments for male urinary incontinence.