Persistent incontinence… When to consider surgery?
Continence is provided by 2 sphincters, the bladder neck sphincter (called the smooth sphincter) and the sub-prostatic or perineal sphincter (striated sphincter). This contraction length and strength varies from person to person. If you have persistent incontinence, read on.
During a radical prostatectomy, the entire prostate is removed along with the bladder neck or smooth sphincter and the seminal vesicles, these small pockets serving as a reservoir for sperm produced by the prostate. The perineal sphincter remains the only sphincter to ensure your continence and its action must often be reinforced by rehabilitation to allow permanent continence and during physical efforts. Basically, this rehabilitation consists of contracting your pelvic floor muscles and relaxing them - this is called Kegel exercises - otherwise, working with a physiotherapist specialized in perineal and pelvic rehabilitation before and after prostate cancer, like radical surgery.
Most of the time, your continence improves steadily to become practically normal, despite the occasional leaking of a few drops which is nothing to be embarrassed about.
However, if lifestyle changes, exercises, or the rehabilitation program with your physiotherapist do not improve your urinary problems, surgery may be helpful. Surgical treatment is primarily aimed at correcting stress urinary incontinence. If you are offered surgery, your doctor will first do tests, such as a cystoscopy, to look for a blockage or narrowing of the urethra (stenosis) to rule out any underlying cause.
There are different surgical options:
Suburethral slings - This type of surgery is mainly for patients with weak (one daily protection) or moderate (two or three pads daily) urinary incontinence. The surgeon places a sling to support your weakened muscles (muscles used to control the flow of urine from the bladder) and prevent urine leakage.
Artificial urinary sphincter - In the event of severe urinary incontinence, the installation of an artificial urinary sphincter may be proposed. It is most often addressed to patients with severe urinary incontinence (more than 4 protections per day). A sleeve is put around your urethra to compress it. This sleeve can deflate to go to urinate by activating a mechanical valve that is installed in the scrotum. This surgery is the most effective but is more complex and requires constant handling on your part.
The choice of treatment is based on your background (general condition, age, diseases already known), your clinical situation (leakage characteristics), the surgeon’s experience, and your level of motivation.
If you have been incontinent for more than a year, talk to your urologist.
Take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease with our expert lectures, our section on available resources, the support that is offered to you.
Do you have any questions or concerns? Above all, do not hesitate. Contact us at 1 855 899-2873 to discuss with a nurse specializing in uro-oncology. It's simple and free, like all our services.
A webinar that might interest you (in French only)
Urinary, sexual or intestinal problems? with Dr, Thierry Lebeau – September 2020
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