Post-prostatectomy Incontinence

After prostate surgery, either radical prostatectomy (for cancer) or less commonly transurethral resection of the prostate (TURP, for prostate enlargement), stress urinary incontinence may develop. This is involuntary loss of urine with cough, sneeze, changes in position, etc. It results from damage to the urinary sphincter muscle that normally maintains continence. It may be temporary or permanent. If bothersome, treatment options are available. Medications may be used, but are unlikely to improve the condition much. Usually, a surgical procedure is recommended.

The least invasive surgical option for this condition is the use of urethral injections of bulking agents to improve the function of the sphincter. The injections are done under local anesthesia and can be repeated. Unfortunately, the cure rate is only 10 to 30 percent.

Another alternative is to perform a male sling. Here a strip of tissue is surgically implanted beneath the skin between the scrotum and the rectum. It acts by compressing the urethra effectively blocking urinary leakage (like stepping on a garden hose). The results are preliminary but promising at this time. It is used for less severe grades of stress urinary incontinence.

The gold-standard treatment for male stress incontinence is implantation of an artificial urinary sphincter. The device is inserted under the skin and consists of a cuff around the urethra, a fluid-filled, pressure-regulating balloon in the abdomen and a pump in the scrotum which is controlled by the patient. The fluid in the abdominal balloon is transferred to the urethra cuff, closing the urethra and preventing leakage of urine.