AUA Guidelines on Incontinence after Prostate Surgery
Recently, the American Urological Association (AUA) published its recommendations on incontinence after prostate cancer treatment, saying that the condition is “predictable and perhaps preventable.”
First and foremost, the AUA statement recommends advising patients undergoing radical prostatectomy that incontinence is expected in the short-term. Most men are not continent when their catheter is removed following surgery. However, continence generally improves to near baseline within a year after surgery. Long-term urinary incontinence is rare after a prostatectomy.
The guidelines suggest that patients be offered pelvic floor muscle exercises or pelvic floor muscle training before and after treatment, particularly right after surgery. Some research has demonstrated that patients who perform pelvic floor muscle exercises after their catheter is removed generally regain continence faster, as well as patients who strengthen their pelvic floor before having surgery.
The pelvic floor physical therapy involves training men to correctly strengthen their pelvic floor muscles. It can sometimes be difficult to achieve this on your own, as the “hidden” pelvic floor muscles can be challenging to pinpoint. Some physical therapists specialize in this particular field and use biofeedback technology to help patients identify their pelvic floor muscles and verify they are working on the correct muscle group.
If problems persist
If incontinence is not improving despite conservative therapy, the AUA statement suggests patients consider surgery for stress urinary incontinence six months to one year after prostate treatment. In contrast, Dr. Catalona recommends waiting for 18 months.
Surgical treatment options include an artificial urinary sphincter, male slings, and balloon devices. All options have benefits and drawbacks, so patients should discuss these options with their doctor.
While the AUA guideline statement is meant as a guideline for clinicians, the information is applicable to patients. The statement, including details of the scientific evidence reviewed by the panel, is available on the AUA website. The statement was also published in the journal Urology in August 2019.