The realities of a prostate cancer diagnosis extend well beyond the need for treatment decisions. Rumors abound regarding the risk of damage to urinary control and sexual potency – functions that are core to a man’s well-being and sense of worth. But the prospect of living with incontinence after prostate cancer surgery does not have to be the ominous cloud men fear. The decisions a man makes about treating prostate cancer, the preparations for that treatment and the follow-up care received each have a great impact on a man’s urinary health.
For most men, robotic prostatectomy surgery is the best form of prostate cancer treatment. Complete removal of the prostate and surrounding cancer offers men the strongest chance of cure and survival. But as with many cancers, treatment can bring the bad with the good. Some degree of urinary incontinence after prostate surgery, though often short-term, is a reality of recovery.
The type of urinary incontinence most often experienced by prostate cancer survivors is called stress incontinence. As a result of disruption or damage during surgery, the sphincter muscles that control the release of urine may be weakened. The level of incontinence varies; some men may have slight leaking or dripping, while others may experience complete bladder emptying. This unwanted release of urine can happen at any time. Strenuous activities and sports are a culprit, or a simple laugh, cough, sneeze or change of position may trigger it. Biologically, this type of incontinence is actually very similar to what some women experience post-childbirth. For men who choose radiation therapy, a different type of incontinence called urge incontinence may be experienced. Urge incontinence is characterized by frequent urination and the urge to “go” immediately, resulting in not being able to get to the restroom fast enough.
Some degree of incontinence and prostate surgery do go hand-in-hand, but educating yourself about surgical methods and specialists can help temper the level of incontinence you experience. Robotic radical prostatectomy is Dr. Samadi’s recommended treatment for men with localized prostate cancer. Dr. Samadi has performed over 7,000+ successful robotic prostatectomy procedures, partnering his traditional surgical foundation with a high level of robotic surgery expertise. The key advantages of robotic surgery over traditional, open surgery are enhanced visibility and dexterity. Blood loss is minimal during robotic surgery, so Dr. Samadi is able to rely on sight over touch. The 3D imaging and 10x magnification, paired with the dexterity of the robot in his hands ensure the precision of the surgical procedure.
Employing the da Vinci System, he uses his own SMART (Samadi Modified Advanced Robotic Technique) to remove the prostate and spare urinary and sexual functions. At the beginning of surgery, Dr. Samadi does not suture the dorsal vein complex, allowing him to control the length of the urethra. The more urethra he can leave, the less incontinence and leaking a man will experience after surgery. Further, with robotic surgery a catheter is only needed for roughly one week following surgery, so the patient is more comfortable and there is less trauma to normal urinary function. Sexual performance is also preserved because Dr. Samadi does not open the endopelvic fascia during surgery. Leaving this tissue intact spares the nerve bundles that control sexual function.
A study was published on this subject, explaining urinary incontinence after prostate surgery.
It is important to accept that most men will experience some degree of urinary incontinence after prostate surgery. This is not an indication of long-term damage. Regaining urinary control can take several weeks or months and some men don’t reach their full recovery capacity for a year or more. Age, weight and previous urinary issues are also factors in recovery time. Patients of Dr. Samadi’s who experienced normal continence prior to surgery can expect to regain urinary control within 12 to 13 months.
Obese men are at a significantly greater risk of experiencing urinary incontinence post surgery. Prior to surgery, Dr. Samadi encourages obese men to undergo an aggressive weight loss regimen to optimize their readiness for surgery and recovery. Kegel exercises are recommended for all men to strengthen the urinary sphincter muscles. The exercise is performed in repetitive sets of clenching the muscle that stops urine flow. There is a significant benefit to beginning them prior to surgery and then continuing the exercise routine post operatively.
Men experiencing longer-lasting incontinence issues have a range of treatment options, including collagen injections and even surgery. Longer-term incontinence issues must be addressed, as left untreated they can lead to isolation and depression. Dr. Samadi knows that urinary control and sexual potency are of utmost importance to men recovering from prostate cancer. All patients receive ongoing, compassionate and practical assistance after surgery to help them achieve optimal urinary and sexual function performance.
