Following radical prostatectomy, many men can experience urinary leakage. Urinary control continues to improve mostly in the first 12 months. During the second year following prostate cancer surgery, there is generally only mild improvement in urinary control. Thus I tend to like to wait until at least 12 months following surgery before considering any type of surgical intervention.
Prior to considering what type of procedure is best for the patient, many patient will undergo cystoscopy and assessment of their degree of leakage in the office. Some patients will undergo specialized testing such as videourodynamics. Once these tests are complete, patients will be counseled on the three most common treatment options for male stress incontinence.
- Biofeedback– Biofeedback is very helpful, especially for light leakers. I typically refer my patients to the Pelvic Health Center near the medical center. This center specializes in teaching patients how to strengthen their sphincter and regain urinary control.
- Male sling procedure– This procedure is a surgical procedure where I make a small incision under the scrotum and place a mesh tape to give your urethra and sphincter further support. You will spend one night in the hospital and possibly go home with a catheter the next day. It is important not to do any increased physical activity or heavy lifting for 6 weeks following this procedure. This procedure is generally reserved for mild to moderate urinary incontinence.
- Artificial urinary sphincter procedure– This procedure involves placing a device into the body which can not be seen externally. There is a cuff that goes around the urethra, a pump that is placed in the scrotum, and a small balloon reservoir placed in the lower abdomen. When you want to urinate, you would press he pump in the scrotum, which would open the cuff around the urethra and allow the urine to pass. This is a surgical procedure that will require you to spend one night in the hospital, and you will probably go home without a catheter the following day. This procedure is generally reserved for moderate to severe urinary incontinence.