Urinary incontinence may occur after any treatment for prostate cancer particularly after surgery. Fortunately it is usually temporary, but occasionally it is permanent. There is less than 1% chance of severe incontinence after surgery and less than 3% chance of mild to moderate incontinence requiring pads after surgery.
The factors that predict the likelihood of urinary incontinence after prostate cancer surgery depend on the technique and experience of the surgeon, the age of the patient and the length of the urethra.
The treatment of incontinence after prostate cancer surgery includes pelvic floor exercises, collagen implants, the use of a proact device at the bladder neck or finally the use of the artificial urinary sphincter.
Pelvic floor exercises are used to increase the speed of recovery by strengthening the pelvic floor muscles. It is important to be shown how to perform these exercises correctly as over exercising tends fatigue the muscle.
Collagen implants have been successful but require multiple injections, often between three and seven and only result in approximately 50% improvement. Implants are not suitable if there is severe incontinence, scarring, a very low leak point pressure or previous radiotherapy.
The proact device is a recent treatment, which involves a minor surgical procedure to place two balloons next to the neck of the bladder. This is undertaken as a day only or overnight stay procedure and often takes up to six months of treatment.
Advance sling is a day procedure that alleviates incontinence. The artificial urinary sphincter is useful for severe incontinence and remains the gold standard for controlling urinary incontinence.