Post-Prostatectomy Urinary Incontinence

Post-prostatectomy urinary incontinence (PPI) is the term used to identify the involuntary leakage of urine following radical prostatectomy to treat prostate cancer. 

PPI represents a specific form of stress urinary incontinence where increased abdominal pressure from a cough, sneeze, or simple physical straining results in the leakage of urine. Under normal conditions, this increase in abdominal pressure is managed uneventfully by contraction of the external urinary sphincter, the muscle surrounding the early part of the male urethra, preventing loss of urinary control. During PPI, this sphincter mechanism is insufficient in maintaining closure of the urethra, permitting urinary leakage.

Between 5-10% of patients undergoing radical retropubic prostatectomy for prostate cancer will suffer clinically significant PPI, manageable only with additional therapy.  As many as 30% of patients undergoing prostate cancer surgery will notice some degree of urinary incontinence postoperatively.  The majority of these patients will, however, regain urinary control within the first post-operative year and require no additional therapy.  If after 9-12 months the patient is dissatisfied with his level of urinary control, a discussion of the artificial urinary sphincter (AMS-800) is appropriate.

The AUS-800 represents the most effective cure for PPI.  Over 90% of patients report satisfactory urinary control following implantation and a similar percentage of patients report that they would both undergo the procedure again and would recommend implantation to a friend suffering similar difficulties.  The AUS-800 can be implanted in under 1 hour through a single small incision in the scrotum which heals with a nearly imperceptible scar.  There are no externalized components and to the casual observer, as in a public shower or restroom facility, it is completely unnoticeable.

Artificial Urinary Sphincter

The AMS-800 is a device known as the artificial urinary sphincter.  This device is placed completely inside the patient's body to provide simple, discreet urinary control. The patient controls urination simply by squeezing a small pump.

The AMS-800 has proven to be effective in treating urinary incontinence and is considered the gold standard by most urologists. With this device, most patients remain dry with only minor leaks or dribbles of urine, usually during strenuous exercise or exertion. As with any medical procedure, the AMS-800 is not 100% effective in all patients. Some patients may require additional protection.

AdVance Trans-obturator Male Sling for Urinary Incontinence

The AdVance™ Male Sling System from AMS is an innovative, safe and effective procedure for men suffering from mild stress urinary incontinence. AdVance is a minimally invasive outpatient surgery that can restore bladder control the day it is performed.

While moderate to severe cases of incontinence in men have been treated surgically for years, the majority of incontinent men — those only mildly incontinent — have had few attractive medical options until now.

Worldwide, 55 million men suffer from incontinence; 5 million men in the United States. AdVance is a treatment for mild stress urinary incontinence (SUI), a condition in which urine is leaked during physical activity like lifting, exercising, sneezing and coughing. Most are prostate cancer survivors, having undergone surgery for the treatment of their cancer with the often unavoidable outcome of a damaged urinary sphincter. With the advent of the AdVance male sling system, doctors are now able to offer a viable spectrum of incontinence solutions.

AdVance gives physicians the opportunity to provide real incontinence solutions to even more prostate cancer survivors.

With the AdVance procedure, a small "sling" made of synthetic mesh is placed inside the body through small incisions. The sling supports the urethra, restoring normal bladder control. Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities shortly thereafter.

Post-Prostatectomy Urinary Incontinence FAQs

 The normal amount of time between voiding will depend on a number of factors but primarily fluid intake. Normally, with average fluid intake, approximately 8 voids per day are considered to be within the normal range.

 There are two sphincter muscles that keep men continent before radical prostatectomy (RP), the internal urethral sphincter and the external urethral sphincter. The internal sphincter is not under your control and is found at the bottom of the bladder, called the "bladder neck," and in the prostate. This is removed during your surgery because the prostate cannot be taken out without removing this sphincter. You control your external sphincter, which is the muscle you can use to stop your urine stream and the one you can strengthen with pelvic floor muscle (Kegel) exercises. Normally, a healthy external sphincter is sufficient to provide continence. However, after RP, there can be some damage or dysfunction of the external sphincter, which can prevent you from recovering your bladder control. This may be due to damage to the nerves, blood supply, supporting structures, or the muscle itself as the external sphincter is located at the apex of the prostate gland.

 There are two main types of urinary incontinence in men after radical protatectomy:

  • Urgency incontinence
  • Stress urinary incontinence

Urgency incontinence is when you feel the "urge" to urinate but cannot make it to the toilet in time. This is generally due to bladder spasms and often responds to medical therapy. This type of incontinence is thought to be mostly due to changes in the way the bladder behaves after surgery.

Stress urinary incontinence (SUI), is leakage of urine with exertion or effort and can happen when you cough, sneeze, lift something heavy, change position, swing a golf club or exercise. This type of incontinence may be because of damage to your external sphincter muscle as described above. Almost all men will have some degree of SUI immediately after catheter removal, and you were probably given instructions on how to perform pelvic floor exercises to improve urinary control.

 No, most men see a quick improvement in continence over the first several months after the catheter is removed, but incontinence can remain troublesome in some men 1 year after surgery. Most surgeons will consider a man continent if they do not regularly use incontinence pads and only have occasional dribbling with lots of activity. Most importantly, however, is how bothersome your urinary incontinence is to you, as our goal is to improve your quality of life as much as possible.