Urinary incontinence after prostatectomy

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was reviewed on September 12, 2022.

Urinary incontinence, or accidental urine leakage, results from a loss of bladder control. Guidelines from the American Urological Association (AUA) recommend that all men undergoing a radical prostatectomy—a type of prostate cancer surgery that removes the the prostate—should expect incontinence after this surgery. Still, for most, urinary function gradually returns to normal over time.

Why does prostatectomy cause incontinence?

Incontinence typically occurs after a prostatectomy because one of the valves that control urine flow is removed along with the prostate. Loss of this valve, along with possible nerve or muscle damage, may lead to incontinence. The different types of incontinence include:

  • Stress incontinence, or leaking of urine when stress is put on the bladder from coughing, sneezing or lifting
  • Urge incontinence, or the loss of urine due to a sudden and strong urge to urinate that can’t be held
  • Mixed incontinence, both types together

How long does urinary incontinence last after a prostatectomy?

It’s impossible to predict exactly how long incontinence may last because each man is different. Incontinence can be affected by your:

  • Cancer stage
  • Weight
  • Age
  • Level of bladder control before surgery

Symptoms may last a few months to a year, and sometimes longer. You’ll typically go back to your normal state within 12 months, according to the AUA.

What treatment is available?

You’ll likely start preemptive treatment with pelvic floor muscle training—exercises that strengthen the muscles that control urination—before surgery. These exercises should also be done right after surgery and continued during recovery.

Kegel exercises, for example, are an important part of strengthening muscles that control urine flow. A physical therapist can help patients learn how to tighten and relax these muscles. Physical therapy may also include strengthening core muscles, including muscles in the back and abdomen that also help control urine. Once you learn these exercises, you can do them throughout the day.

For men who have significant stress incontinence that continues past six to 12 months, two surgical procedures may help.

  • Male urinary sling procedure may help with mild to moderate incontinence.
  • Artificial urinary sphincter surgery is used for men with more severe incontinence.

Before prostate cancer surgery, you’re likely to have an evaluation that includes urine flow and control testing, called urodynamic testing. Patients should undergo an internal examination of the urethra (the tube that carries urine from the bladder through the penis) and bladder using a scope passed through the penis into the bladder. The procedure is called a cystourethroscopy.

Male urethral sling surgery: This is often the first surgery to treat mild incontinence, or incontinence that requires no more than two to three absorbent pads per day. During this procedure, a man-made (synthetic) tape, called a mesh, is placed around the urethra to move it into a position that makes it easier to control urine flow. Repositioning the urethra gives a more natural sensation of the urge to pass urine. This procedure can be done through a small incision in the perineum (between the anus and the scrotum) or in the groin. This surgery’s success rate is good, but results may decline over a number of years.

Artificial urinary sphincter surgery: The AUA recommends this procedure for men who still experience incontinence after a urinary sling procedure or for severe incontinence, meaning you need to use three or more absorbent pads per day. It involves placing an inflatable cuff around the urethra. A reservoir that contains fluid to inflate the cuff is placed in the scrotum, or in the abdomen, along with a pump. When you have the urge to pass urine, pressing the pump in the scrotum opens the cuff to allow urine to flow. After you’ve urinated, the cuff automatically draws fluid from the reservoir to re-inflate and close off flow. This procedure is successful about 90 percent of the time, but it requires the ability to use the pump. It may not be appropriate for a man with poor manual dexterity or dementia. Also, as it’s a mechanical device, there is the potential for a malfunction. As with the sling, this device may decline over time and may need to be replaced.

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