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Post Prostatectomy Incontinence

Around 1 in 10 men who have had a radical prostatectomy for prostate cancer may experience some loss of control of their bladder. Post Prostatectomy Incontinence (PPI) can vary in severity, from an occasional small urine leak during strenuous exertion to larger or more frequent leaks. Incontinence can sometimes happen after a TURP operation for benign prostate enlargement too, but this is not common.
Incontinence is quite common immediately after surgery but urinary control should start to improve in the first few weeks after the operation. It may take several months for full control to return, however. Most men are taught pelvic floor exercises before or straight after their surgery to help them prevent and/or reduce incontinence.

Why does Post Prostatectomy Incontinence happen?

During a radical prostatectomy, small nerves and blood vessels running alongside the prostate may be damaged as the prostate is removed. These nerves and blood vessels are needed for the urinary sphincter muscle to work properly. Also, because the urinary sphincter is just below the prostate gland, it can be stretched or damaged when the prostate is removed. All these factors can stop the sphincter contracting strongly enough and cause incontinence.

How can Post Prostatectomy Incontinence be prevented?

Some patients are more at risk of Post Prostatectomy Incontinence. If you have a larger prostate cancer, then there is a higher chance of damage because the surgeon has to be sure or removing all of the cancer. If you have radiotherapy treatment to the prostate area, either before or after surgery, then the risk of incontinence is increased also. The main risk factors for Post Prostatectomy Incontinence are listed below:
  • Radiotherapy (either before or after prostate surgery)
  • More advanced prostate cancer
  • Age (older men have a higher risk of Post Prostatectomy Incontinence)
  • Previous bladder control problems
  • Surgical technique
The expertise of the surgeon is an important factor in the development of Post Prostatectomy Incontinence. There is good evidence that more experienced surgeons have lower complication rates and this is also true for Post Prostatectomy Incontinence. Your surgeon should be able to tell you how many operations he has done and what his complication rates are.
Nottingham Urology Group consultants have large NHS practices treating prostate cancer patients and regularly perform radical prostatectomies in large numbers. Data submitted to the BAUS National database for major cancer operations show that Nottingham is one of the busiest cancer centres in the UK and our complication rates are low.

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