Managing Urinary Incontinence

Urinary incontinence and prostate cancer

Urinary incontinence may occur after any treatment for prostate cancer particularly after surgery. Fortunately it is usually tempory, but occasionally it is permanent. Recent results from our own series at St Vincent’s and from many other large series throughout the world suggest that there is a less than 1% chance of severe incontinence after surgery, and less than 3% chance of even mild to moderate incontinence requiring pads after surgery.

The factors that predict the likelihood of urinary incontinence after prostate cancer surgery depends on the technique and experience of the surgeon, the age of the patient, and the length of the urethra. Recently some work has been done in New York to show that one can measure the length of the urethra with magnetic resonance imaging, and this can improve the accuracy of prediction of urinary incontinence after surgery.

The treatment of incontinence after prostate cancer surgery, includes pelvic floor exercises, collagen implants, the use of a proact device at the bladder neck, or finally the use of the artificial urinary sphincter.

Pelvic floor exercises are used to increase the speed of recovery by strengthening the pelvic floor muscles. It is important to be shown how to perform these exercises properly and overdoing the exercises will tend to fatigue the muscle.

Collagen implants have been shown to be successful but require multiple injections, often between three and seven implants, and one can only expect about a 50% improvement. It is not suitable if there is severe incontinence or if there is a lot of scarring or a very low leak point pressure or previous radiotherapy.

Collagen implant Proact device

The proact device is a newer treatment which involves a minor surgical procedure to place two balloons next to the bladder neck. This is done as a day only or overnight stay procedure. It gives one the opportunity to top up the balloons until urinary control is markedly improved or perfect. It often takes up to six months to get to that stage. There is a 10% risk of infection and a 10% chance of incorrectly positioning these balloons, or erosions. Four-year results appear to have very promising outcomes at this stage. At St Vincent’s we have been performing these for almost two years and results are very encouraging.

The artificial urinary (fig) sphincter is useful for severe incontinence. 90% of people are satisfied with the outcomes. Between 10 and 70% of people are completely dry, and virtually everybody is has acceptable urinary control. There is a 3 to 4% chance of revisions per year. This remains the gold standard for controlling urinary incontinence when the incontinence is severe.

Artificial Urinary Sphincter