Urinary Incontinence After Prostate Cancer and the Artificial Urinary Sphincter
Why does urinary incontinence occur after radical prostatectomy, and does it recover? Pelvic floor exercises, the waiting period and the artificial urinary sphincter (AUS) for persistent leakage.
After prostate cancer surgery (radical prostatectomy), a problem some men face — one they are reluctant to talk about yet which deeply affects quality of life — is urinary incontinence. This is not a source of shame but a treatable medical condition. In most patients it improves markedly over time; where it does not, effective surgical solutions exist.
Why does incontinence occur after surgery?
Part of the muscular mechanism that holds urine lies immediately around the prostate. Removing the prostate because of cancer can affect this region; in addition, reconnecting the bladder to the urethra can leave the holding function weak for a while. That is why, especially in the first weeks, urine leakage of the stress type may be seen when coughing, laughing or lifting — situations that raise intra-abdominal pressure.
Does incontinence resolve on its own?
In most patients, yes. Leakage decreases gradually over the months after surgery, and many men recover largely or completely within the first year. During this period, pelvic floor exercises (Kegel) and, where needed, pelvic floor rehabilitation can speed recovery. Patience and regular exercise are the two most important elements of this phase; an adequate waiting period is allowed before moving to a permanent solution.
What options exist for persistent incontinence?
If leakage continues despite an adequate waiting and rehabilitation period, surgical options are considered according to the degree of leakage:
- Male sling surgery: in mild-to-moderate leakage, a supportive tape is placed to support the urethra.
- Artificial urinary sphincter (AUS): accepted as the gold standard in moderate-to-severe leakage.
What is the artificial urinary sphincter (AUS), and how does it work?
The artificial urinary sphincter is a system entirely concealed within the body, consisting of a cuff around the urethra, a small pump placed in the scrotum and a fluid reservoir. Normally the cuff keeps the urethra closed and prevents leakage. When the patient wants to urinate, he presses the scrotal pump a few times; the cuff opens temporarily and the bladder empties, after which the cuff closes again by itself. This lets the person control urination voluntarily. The device is invisible from the outside and does not restrict daily life.
Who is it suitable for?
The artificial urinary sphincter provides high satisfaction in patients with persistent, significant leakage after surgery who have the manual dexterity to use the pump. The decision is made by weighing the degree of leakage, the patient's general condition and expectations together. It is a solution that frees the patient from pad dependence, allows a confident return to social life and markedly improves quality of life. Do not hesitate to discuss it openly with your doctor; incontinence is not a fate to be silently endured.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; assessments of urinary incontinence after prostate cancer are carried out with individualised planning and full confidentiality.