Incontinence can be classified as:
Stress urinary incontinence is less common in men as compared to women. Most occur after radical treatments of surgery or radiotherapy for prostate cancer. Less commonly it can occur due to other causes such as surgery for benign prostatic enlargement, pelvic trauma or neurological disease. Urge urinary incontinence becomes more prevalent as one gets older. It can happen secondary to an enlarged prostate causing urinary blockage, infection, bladder tumour or neurological disease.
Incontinence after Surgery for Prostate Cancer
Pelvic floor exercises starting before and continued after the surgery can assist with the earlier return of muscle sphincter function. Improvement is possible up to 12 to 18 months after surgery.
For those with ongoing bothersome incontinence despite pelvic floor exercises, an assessment for surgical treatment is appropriate. The assessment will involve taking a history, physical examination and a urine test to exclude a urinary tract infection. A cystoscopy is useful to make sure that there is no excessive scar tissue at the bladder neck (bladder neck contracture) and to assess the function of the urethral sphincter. A urodynamic study (bladder function test) gives information about bladder storage function, pressure at which stress leakage occurs and bladder voiding function. A 24 hour pad weight give an indication of the severity of incontinence.
Surgical options for stress incontinence include a male sling (for mild to moderate incontinence) and an artificial urinary sphincter (moderate to severe incontinence). The AdVance™ male sling lifts and supports the urethral sphincter to improve its function and relies on a functioning sphincter to achieve dryness. The artificial urinary sphincter is a mechanical device which consists of a urethral cuff, a scrotal pump which is placed next to the testicle and a balloon reservoir which is placed in the pelvis next to the bladder. Your urologist will advise the most appropriate device for your level of incontinence. There are other anti-incontinence devices available which may be appropriate based on the surgeon’s experience and patient factors.