In our Ask the Experts series, we’ll put a real patient question to one of the Grace Prostate Cancer Centre’s urologists, and they’ll offer up an honest, candid response.
Today, we asked Bay of Plenty Urologist Andre Westenberg about a common concern among patients regarding prostate cancer and incontinence.
If my continence doesn’t improve when it’s supposed to after prostate cancer treatment, will I ever be dry again?
Yes it is likely that your continence can be improved!
The reason that post-operative leakage occurs is that the apex of the prostate is intimately associated with the sphincter muscle that controls urinary continence. In order to remove the prostate this muscle needs to be divided. It is therefore fairly common for patients to have a period of post-operative urinary leakage after surgical treatment for prostate cancer.
In most this is a temporary situation and more than 90% of patients will be able to do away with their incontinence pads after 10-12 weeks post-operatively. In a few however the leakage persists.
There are two broad patient groups – those with minor, somewhat annoying leakage mostly related to exercise and those with very significant leakage requiring the use of several incontinence pads per day. If the leakage is low volume and only with fairly major exertion then probably all that is needed is time. Pelvic floor exercises can be very useful in this group.
Incontinence can continue to improve for up to a year although the majority of the improvement takes place in the first few months postoperatively. If the leakage continues beyond a year then it is unlikely that there will be further significant improvement.
At this level of leakage a procedure such as placement of an AdVance sling is very likely to resolve the issue.
The AdVance sling is a polypropylene mesh which repositions the sphincter complex and is very successful in controlling relatively minor levels of leakage. The advantage of this procedure is that one is able to void normally without having to pump a device in the scrotum. If the leakage continues to be very severe after 3-4 months then it is unlikely that you will achieve normal continence by yourself. A small number of patients in this group will be helped with a sling but it is more likely that you will need an artificial urinary sphincter.
This is a device which uses a silicone cuff around the urethra and a pump in the scrotum which needs to be pushed every time you need to void.
Both these devices, in appropriately selected patients are very reliable in controlling urinary leakage.
If you have very significant leakage it is possible that any corrective surgery will be funded by ACC. For further information concerning post-operative leakage and treatment options please visit bayurology.co.nz.
