After My Catheter is Removed, Will I Leak Urine?

The majority of men will initially leak urine especially when pressure is applied to the abdomen (i.e. coughing, sneezing, lifting, standing from a sitting or lying position).

When Can I Expect to Become Dry?

Return of urinary control varies from man to man. Men who have a robotic prostatectomy usually regain urinary control more quickly than men who have the traditional open procedure. In one study, ¾ of the men did not need urinary pads just 3 months after their surgery. Studies show 75% to 93% of men have regained full urinary control 1 year after their surgery and that less than 5% are still having problems with control eighteen months after their surgery.

What if I am Still Wearing Urinary Pads 12-18 Months After My Surgery?

There are additional surgical treatment options for men with persistent incontinence:

Urethral Bulking Agents

Bulking agents are the least invasive short term treatment for urinary incontinence. While asleep a telescopic lens is placed through the penis to the junction between the bladder and urethra. A bulking agent (synthetic material) is injected near the urinary sphincter to narrow the urinary channel.

Bulking agents have been shown to decrease pad usage by 50%. Repeat injections are required on average every 7 months. Patients with a history of bladder neck scarring or prior external beam radiation therapy are not candidates for bulking agents.

Bulbourethral Sling

Under anesthesia, a small incision is made to expose the urethra under the scrotum. A synthetic material is placed under the urethra to give it support.

Studies have shown that after the sling procedure 30% of patients are down to zero urinary pads per day and another 63-79% are down to 1 or 2 urinary pads per day. Patients with a history of prior external beam radiation therapy are not candidates for the bulbourethral sling procedure.

Artificial Urinary Sphincter (AUS)

The AUS is the most effective treatment for incontinence after prostatectomy. A fluid filled reservoir roughly the size of a golf ball is implanted in the groin area next to the bladder. A pump device about the size and shape of the thumb is placed inside the scrotum in front of one of the testicles. The last piece is a circular inflatable cuff that is placed around the urethra and sphincter area.  When activated, the cuff compresses the urethra with sufficient pressure to withstand forces associated with most activities. When one has the usual sensation of a full bladder, the pump in the scrotum is pressed between the fingers twice to allow the cuff to open. Voiding is completed in the normal fashion and the device automatically closes over 1-2 minutes. Implantation of this device generally requires a 2 hour surgery and an overnight stay in the hospital.

Studies have shown that after the AUS procedure 59-84% of patients are down to 1 or less urinary pads per day. The AUS needs to be revised or replaced on average every 7 years. Patients with a history of prior external beam radiation therapy or bladder neck surgery are candidates for the procedure.

What Are Some Temporary or Conservative Means to Control Leakage?

After the operation it takes time for the brain to reconnect to your sphincter to control leakage. However, you may need some help during social events with urinary control and the following devices may assist you.

Condom Catheter

A condom device is attached to a drainage tube and a collection bag. It can be adjusted for fit and secured to the penis with paste or Velcro strap.

Cunningham Clamp

This clamp can be placed on the penis to apply light pressure to the urethral canal on the underside of the penis to prevent leakage. It can be adjusted to fit properly and should not be set too tight or it will interfere with blood flow.

McGuire Urinal

This is a self contained unit that holds about 150 ml of urine. It can also be used with a leg bag that can store up to 1000 ml of urine.

Designed in a style similar to an athletic supporter, there are 2 styles available.

Original version: has a sewn-in sheath and a fabric waistband that is not adjustable. (It is, however elasticized and accommodates 2 different, but specific, waist size ranges.)

Uni-Size: adjustable in 3 positions, each with a different size range (26” to 44”). The sheath snaps on, so it can be replaced.

This device is popular among men who are sensitive to adhesives.

Acticuf ™

A disposable pouch that is placed on the penis to manage light to moderate urinary incontinence.  It gently presses down on the urethra to control urinary flow, and the padding of the pouch absorbs leakage.

Urinary Incontinence during Sex

Climacturia is incontinence (leakage of urine) associated with male sexual arousal or orgasm.  If you are experiencing this problem, try to void before intercourse and then use a condom.

Is There Anything I Can Do Before Surgery to Decrease My Chances of Urinary Leakage?

Starting kegel exercises prior to surgery has been shown to hasten return of urinary control.

Start doing your kegel exercises IMMEDIATELY.

Kegel Exercises

What are the Pelvic Muscles?

The pelvic muscles are a large mass of muscles that run from the pubic bone to the tailbone. Both the rectum and urine channel run through these pelvic muscles that help hold the bladder and bowel in place.

These are not muscles you exercise regularly. When you are younger, these muscles are as tight as a trampoline and they bounce back when we cough or sneeze. As you get older, these muscles relax and weaken, and act more like a hammock than a trampoline.

What are the Benefits of the Kegel Exercises?

These exercises help people regain urinary control when they are done regularly.

If you are motivated, you can do the exercises on your own effectively. Most people begin to see results in a few weeks, but for those men whose muscles are extremely weak, the results may not be noticeable for several months. If your progress seems slow, do not become discouraged and stop before these muscles make significant progress.

Strengthening your pelvic muscles can also help your incontinence by enabling you to hold urine in the bladder until the urge passes so that you can get to the toilet before leakage occurs.

How do I Locate the Pelvic Muscles?

The following methods have been used to help identify the specific muscles that you will be exercising with the Kegel exercises:

• Tighten the ring of muscles around the rectum as if you wanted to avoid passing gas or having a bowel movement. You should feel a "drawing up" or tightening between your legs.
• Stand in front of a mirror and look at your penis. Try to make your penis move up and down without moving the rest of your body. If you can, you are using the right muscles.

While standing at the toilet, tighten your muscles and stop the flow of urine. If you cannot stop the flow, try again.

How Do I Exercise the Pelvic Muscle?

• First, empty your bladder. Then relax.
• Tighten the muscle and hold for 20 seconds, then relax the muscle completely for 20 seconds. You should feel a pulling sensation around your rectum.
• Repeat 20 times, tightening and relaxing for each set. Repeat the set 5 times per day.

When Should I Exercise the Pelvic Muscle?

These exercises may be done at any time: watching TV, riding in a car, etc. At first you may not be able to hold this contraction for the full count of 20 seconds; however, you will slowly build up to this. The muscle may start to tire after about 6 or 8 exercises. If this happens, stop and go back to exercising later.

What are Some Common Mistakes?

Never use your stomach, legs or buttock muscles. To find out if you are using your stomach muscle, place your hand on your abdomen while you squeeze your pelvic muscle. If you feel your abdomen move, then you are using these muscles. In time, you will learn to practice effortlessly, eventually working these exercises into your lifestyle: tighten when you walk, before you sneeze, etc.

When Will I Notice a Change?

After a couple of weeks of constant daily exercise, you will begin to notice less urinary accidents and after 3 months, you will see an even bigger improvement.

Can These Exercises Hurt Me?

NO! These exercises cannot harm you in any way. Most people find them relaxing. If you feel back or stomach pain after you exercise, then you are probably trying too hard and using your stomach muscles. Go back and find the pelvic muscle, and remember this exercise should feel easy. Remember to relax.