The majority of men will initially leak urine, especially when pressure is applied to the abdomen (e.g., coughing, sneezing, lifting, standing from a sitting or lying position).
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, just three months after their surgery 3⁄4 of the men did not need urinary pads. Studies show 75% to 93% of men have regained full urinary control one year after their surgery, and fewer than 5% are still having problems with control eighteen months after their surgery.
There are additional surgical treatment options for men with persistent incontinence:
Bulking agents are the least-invasive short-term treatment for urinary incontinence. While the patient is 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 seven months. Patients with a history of bladder neck scarring or prior external beam radiation therapy are not candidates for bulking agents.
While the patient is 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 one or two urinary pads per day. Patients with a history of prior external beam radiation therapy are not candidates for the bulbourethral sling procedure.
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 two-hour surgery and an overnight stay in the hospital.
Studies have shown that after the AUS procedure, 59-84% of patients are down to one or fewer urinary pads per day. The AUS needs to be revised or replaced on average every seven years. Patients with a history of prior external beam radiation therapy or bladder neck surgery are candidates for the procedure.
After the operation, it takes time for the brain to reconnect to your sphincter to control leakage. However, you may need some help with urinary control during social events and the following devices may assist you.
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.
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.
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. This device is popular among men who are sensitive to adhesives. Designed in a style similar to an athletic supporter, there are two styles available.
The uni-size is adjustable in three positions, each with a different size range (26" to 44"). The sheath snaps on, so it can be replaced.
The Acticuf is 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.
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.