Incontinence is the inability to control your urine. After prostate cancer treatment, you may experience leakage or dribbling of urine. This may result form surgery, radiation therapy, prostate freezing and other treatment options for prostate cancer.
Because incontinence may affect your physical and emotional recovery, it is important to understand what your options are.
There are several different types of incontinence:
Improvement can take several weeks to several months. It varies from patient to patient; your particular recovery could be quick or slow and depend on the type of treatment you received for your prostate cancer.
Treatment is based on numerous factors including the type and severity of your incontinence as well as the type of treatment you received for the prostate cancer. There are a variety of treatment options which can potentially help you regain complete control:
It is important to know what side effects you might experience with each of the available treatment options.
It is always important to speak with your doctor if you are experiencing any urinary issues after your prostate cancer treatment. As a team, you can determine what will be best for you.
The sling may help keep you dry by elevating and lengthening the part of the urethra that contains your sphincter valve so that the sphincter muscle can function properly. It works best in men whose own urinary sphincter muscle looks good (we determine this when we looked into your bladder with the telescope). It does not work well in men with very high volume of incontinence (greater than 500 cc a day), whose sphincter is scarred and does not work well or in men with prior radiation therapy.
The best candidates are men who have not had radiation therapy, have a lower volume of urinary loss per day, have a good sphincter valve when looked at with the scope and have good muscle activity. In the ideal candidate it may significantly improve your continence. You may still have some leakage with strenuous activities, coughing, etc. Some men choose to try a sling even if they are not perfect candidates rather than go right to an artificial urinary sphincter.
If we do not achieve our goals with the sling we still have options. Some men have been treated in the past with a second sling but we currently feel the next best option is the artificial urinary sphincter. You can safely have an artificial urinary sphincter, if needed, after a sling.
We do not think the sling is a good option for men with a prior history of radiation therapy for the prostate cancer.
Men who leak urine have other alternatives including the artificial urinary sphincter, externally worn clamps or urine collection devices and urinary pads or diapers.
The risk of the male transobturator sling include bleeding, infection, need for reoperation to remove the sling (rare), inability to urinate immediately after surgery, incomplete treatment of the incontinence, and damage to other structures such as the urethra or rectum. Additionally, it’s important to understand that the fda has a warning about the use of this type of mesh in women but does not currently have any warnings issued for the use in men.
Because some men have difficulty urinating immediately after the surgery due to some swelling, we will leave a catheter in the bladder after surgery. You will be instructed on how to remove this by yourself the day after surgery.
It is very important that you do not have a urinary tract infection at the time of surgery. A urine culture will need to be checked roughly 2-4 weeks prior to your procedure date.
You cannot eat or drink anything after midnight on the night prior to your surgery. Take your morning medications as instructed by the anesthesia pre-op clinic.
A family member/friend must accompany you to the surgery, stay the entire time while you are in surgery and be able to drive you home afterwards. You will not be able to drive yourself home.
The sling is done through an incision in your perineum (the area between the back of your scrotum and your rectum) and 2 small incisions on the scrotum. It involves using 2 trocars to help position the sling and elevate the urethra. The sling (a strip of mesh) is designed to elevate and lengthen the urethra so that your own sphincter muscle can function properly. The surgery takes 60 minutes and can be done under spinal or general anesthesia. There are no stitches or bandages that have to be removed. All the stitches will dissolve on their own. We use skin glue to seal the small incisions on your scrotum.
After surgery, you will go to the recovery room. You will go home with a catheter in the urethra and we will teach you how to remove this at home the day after surgery. We will give you more information on this in the recovery room.
We recommend using a donut/hemorrhoid pillow when sitting on hard surfaces. You can purchase this at any pharmacy for this purpose. Once the recovery room team feels you are ready, you will be discharged from the hospital.
It is important that you get up and walk around as soon as possible after surgery. Because the sling is not sewn into place, your body needs time to “grow” into the sling and make the attachment strong. You need to avoid lifting anything >10 pounds for 6 weeks following surgery. We recommend avoiding strenuous activity as well as those activities that result in squatting or raising the legs. Use caution getting in/out of larger cars as we do not want you to raise your legs more than 90˚ and do not do any activities that require you to spread your legs wider than your shoulders.
You should plan to be out of work for at least a week following surgery. Your ability to return to work after surgery depends on your work requirements. It is important that you follow the activity restrictions as mentioned above for 3-4 weeks following surgery.
You should not drive while you are taking pain medications. We recommend not driving for at least 3 days following surgery. You cannot drive if you are still taking narcotic pain medication or have limited mobility.
We will see you back in the urology clinic 6 weeks after the surgery. Our staff will be in contact with you periodically after surgery.