If you've been impacted by prostate cancer, you may have experienced some form of urinary incontinence (UI). The good news is - there are support and treatment options available for many men.
PCFA's Clinical Nurse Manager Debra Ward explains.
PCFA's Telenursing Service fields a high number of calls from men seeking information and support in the management of UI, including urinary and bowel problems, bladder leakage and a spectrum of continence issues.
Recent data tells us that while treatments for men with more advanced prostate cancers can cause urinary problems, those who on active surveillance or watchful waiting (where no treatment is delivered to the prostate) still have a significant degree of "urinary bother".
So what does that mean?
Simply put, the data tells us that UI needs further investigation to determine the cause and the best methods of treatment.
Previous blogs have focused on broad management of urinary leakage and continence aids and subsidies.
But men are not always aware that they may be able to have various treatment options to improve their level of continence.
With National Continence Week this June 19 - 25, we're exploring a range of approaches to UI, including surgical interventions.
Assessment of Urinary Incontinence
It's generally suggested that UI lasting more than 12 months after prostate cancer treatment requires intervention.
Men in this category will undergo a range of assessment and diagnostic tests to establish cause and most appropriate treatment options to achieve bladder control.
Referral to urologist or a urology clinic with a specialty in urinary function control may better assess options for a man with ongoing urinary incontinence.
A study called Urodynamics can provide helpful information and assessment of suitable treatments. Urodynamic testing looks at how the bladder, sphincters and urethra store and release urine and if any functional issues are present. This test is conducted in a clinic or hospital setting prior to any surgical intervention.
Sometimes this also involves a short procedure to view the urinary passages and bladder to assess the extent of the problem causing incontinence. This procedure is called a cystoscopy and can be performed either under local anaesthetic, sedation or general anaesthetic as a day procedure.
For many men, urinary incontinence is controlled and managed effectively within 3 months after treatment (for both surgical removal and radiation).
For some, it may be ongoing with slow improvement over several more months.
For a small percentage of men it can take up to 12 months to reach a satisfactory level of control. During this time the use of specifically shaped male pads or the purchase of washable padded pants are recommended to contain moderate urine loss.
Conservative Management of Urinary Incontinence
Conservative methods of treatment, such as pelvic floor exercises (PVE), are worth considering in the assessment of UI.
All men can benefit from PVE for greater pelvic floor strength and urinary control, particularly those who have undergone prostate cancer treatments.
General fitness has also been shown to assist and support better urinary control in later years with a regular exercise program of strength and conditioning.
Consultation with a specialist Mens and Pelvic health Physiotherapist ( Find a physio - Choose physio | Australian Physiotherapy Association ) provide guidance on the best PVE for your situation.
Surgery for Managing Urinary Incontinence
When conservative management is not effective, and if assessment indicates a need for further intervention, there are a range of surgical options.
The suitability for either a sling or artificial urinary sphincter (AUS) may be discussed as surgical treatment options for men with UI.
When looking at suitability for surgical procedures, the volume of urine loss each 24-hour period is the main criteria.
Other options
Male Pelvic Sling: This is suitable if you have less than 200mls of loss over 24 hours. It requires a general anesthetic and can be performed as day procedure or as a short stay in hospital. It involves wrapping surgical tape around the urethral bulb and gently moving the urethra into a new position to increase resistance in this area.
Postoperative instructions for six weeks include: not lifting anything heavier than 5kg, no strenuous exercise or activities such as bike riding, climbing, squatting and no sexual activity. Your surgeon should provide a full list of instructions. Pain can be expected at the wound site for 2-4 weeks and may be controlled with tablets at home. Short term reduction in urine flow is normal after this procedure.
Artificial Urinary Sphincter: This is a continence device suitable for men with moderate to severe urinary incontinence with a loss greater than 300mls/ day. It consists of a balloon placed in the scrotum that activates a cuff positioned around the urethra in the penis, which is activated by the man each time bladder emptying is required. The operation requires general anesthetic and takes about 60 minutes to complete.
When the cuff is inflated, urine leakage is limited; the man is taught to push the pump to deflate the cuff and allow the passing of urine. The cuff will then re-inflate automatically, after five minutes, to stop any further urine flow.
Following surgery, there may be small wounds to the perineum and abdomen with dissolvable stitches. A urinary catheter may be inserted for a few hours and removed before leaving hospital. The pump is then left in the 'deactivated' position whilst the area heals. Men continue to remain incontinent during this time - a six-week appointment will be scheduled with the surgeon or nurse to 'activate' the device.
What Happens After Surgery?
The instructions and limitations for 6-weeks following Sphincter insertion are similar to the Sling procedure outlined above.
A small percentage of men can experience infection or erosion of the device, or mechanical failure, requiring removal.
Your specialist will discuss all possible complications with you prior to surgery, but it is important to note, there is a high satisfaction rate reported by men that undergo AUS insertion for UI.
Because this is an implanted medical device, a patient identification card will be provided and must be carried at all times.
While these surgical options may be more readily available to men with private health insurance, or those able to self-fund, there are some clinicians who perform these procedures in public hospitals.
Please note that there may be longer waiting times for these categories of procedures through public hospitals. To locate a specialist who works in these areas, we encourage you to follow these links.
This list is by no means exhaustive and PCFA does not recommend individual clinicians.
PCFA will also host a National Continence Call-In Day on Thursday, 22 June 2023 from 9am to 8pm. Call 1800 22 00 99.
