Permanent incontinence after radical surgery

Men are still not fully informed before prostate surgery about urinary incontinence as a late consequence of the procedure.

 The involuntary loss of urine affects many men, despite the fact that surgical techniques are gentle on the nerves. As the German Society of Urology (DGU) has published in the current guidelines for the treatment of prostate cancer, at most one in two patients can no longer hold the urine after radical surgery. Many of the men who have undergone surgery suffer from urinary incontinence permanently and are dependent for life on diapers and diapers. 

Prostate cancer - The diagnosis hits Heinz S. out of the blue. Only 10 days later, the 67-year-old industrial clerk had his prostate gland removed operationally at the Municipal Hospital. He then loses control of his bladder function; he becomes incontinent. Heinz S. is not an isolated case. During surgery, a portion of the bladder sphincter must often be removed. The remaining sphincter muscle is often too weak to retain the urine in the bladder - especially in stressful situations such as coughing, sneezing or pressing,"explains Dr. Derakhshani, urologist at the West German Prostate Center.

Incontinence: severe impairment of quality of life

The problem of being unable to hold the urine is different for men who have undergone surgery and ranges from slight loss of urine and wearing pads to the permanent use of diapers. In many cases, pelvic floor training or medication can improve the symptoms. However, in some cases, incontinence persists permanently or begins a few years after surgery. In a recent study1, Italian urologists investigated the continence status of 235 men in a long-term follow-up (at least 8 years) who were able to hold their urine two years after the operation. As a result, 89 percent of patients remained continental after re-examination and 11 percent of men use one or more templates daily. This means that the incontinence rate is twice as high as for non-operated patients of the same age. The researchers report that the higher number of men who no longer have control over their bladder is mainly due to the abdominal muscles affected by the operation.

Brachytherapy: Less stress on the bladder

It is a fact that urinary incontinence significantly impairs the quality of life of those affected,"emphasizes Derakhshani. This ranges from general insecurity to the loss of social contacts and activities. Some men even don't dare to go on holiday or even leave their flat for a longer period of time. This makes it all the more important,"said the urologist from Cologne," to draw the patient's attention to urinary incontinence as a possible consequence of the surgical intervention in the run-up to the therapy and to include effective but gentle treatment methods such as brachytherapy (inner radiation) in the therapy considerations. 

In brachytherapy, the smallest radiation sources (seeds) are inserted into the prostate. The mini implants remain in the gland and deliver high-dose radiation to the tumor tissue for several months. In this way, the tumor is destroyed without damaging the surrounding tissue. Although a temporary increased urge to urinate can occur after brachytherapy, the dreaded urinary incontinence is spared practically all patients,"emphasizes Derakhshani. In retrospect, Heinz S. klüger is also wiser and would no longer be able to be operated in such a hurried manner, but would first of all be comprehensively informed about the various therapy options with their advantages and disadvantages. 

  1. Naselli A, Simone G, Papalia R, Gallucci M, Introini C, Andreatta R, Puppo P: Late-onset incon-tinence in a cohort of radical prostatectomy patients. Int J Urol. 2011 Jan; 18 (1): 76-9.

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