Urinary leakage after prostate surgery

Why some men leak urine after prostate surgery

The prostate sits just below the bladder. When the prostate is removed for cancer, the bladder has to be re-joined to the urethra, and the muscle that holds urine back has to do more of the work on its own. While this muscle and the surrounding tissues are recovering, some leakage is normal.

How much leakage you get is very variable. Some men have almost none. Others need pads for a while.

What helps things settle

• Careful surgery. A precise operation, with a pelvic floor reconstruction at the time, helps with early control of urine.
• Pelvic floor exercises. Patients are usually taught these before surgery, so they are familiar with them. Exercises are then started about a week after surgery.
• Continence advisor. Seeing a continence advisor is helpful to make sure the exercises are being done correctly.

On average, leakage settles down over 10 to 12 weeks, although for some men it can take up to a year. Most men reach a level of control that is acceptable to them with these simple measures alone.

If leakage is still a problem after about a year

If leakage is still bothersome a year after surgery, there are two main extra options to consider:

• AdVance sling. A synthetic sling, usually inserted as a day procedure, that supports the urethra. It is most useful for men with mild leakage (around 1 to 2 pads a day).
• Artificial urinary sphincter. A small synthetic cuff is placed around the urethra, with a pump tucked into the scrotum and a small fluid reservoir in the abdomen. To pass urine, the man squeezes the pump, the cuff briefly deflates, and then it auto-inflates again. The whole device is hidden under the skin. Studies show this device is effective in around 95% of suitable patients, which means even men with significant leakage usually get a worthwhile result.

The artificial sphincter operation is short - about an hour - and done through a small cut around 2 to 3 cm long.