A prostatectomy is the surgical removal of the prostate gland, most commonly performed to treat prostate cancer. Patients frequently ask about the risk of losing bladder control afterward. Urinary incontinence, the involuntary loss of urine, is a very common potential side effect of prostate removal. This temporary or long-term complication arises from the close anatomical relationship between the prostate and the urinary control mechanism. The majority of men regain satisfactory control over time with appropriate management and recovery strategies.
The Anatomical Link: Why Prostate Removal Affects Urinary Control
The prostate gland is positioned just below the bladder, encircling the first part of the urethra, the tube that carries urine out of the body. Normal urinary control relies on two main muscle groups: the internal sphincter at the bladder neck and the external urinary sphincter located slightly lower. During a radical prostatectomy, the prostate gland and the internal sphincter are necessarily removed.
The patient is then left relying solely on the external urinary sphincter to maintain continence. This voluntary muscle must compensate for the complete loss of the automatic internal sphincter mechanism. Even with careful surgical technique, the external sphincter and the surrounding nerves that control its function can be affected by the dissection.
Damage to the delicate network of nerves and muscles supporting the urethra is a primary cause of post-operative incontinence. The length of the remaining urethra, known as the membranous urethra, is also an important factor in recovery, as surgeons aim to maximize its functional length.
How Common Is Post-Prostatectomy Incontinence?
Following a radical prostatectomy, nearly all men experience some degree of urinary leakage initially, making it a near-universal temporary outcome. The prevalence is naturally very high immediately after surgery, but this rate improves dramatically as the body heals and the remaining sphincter muscle recovers.
Within the first few months, a significant percentage of patients regain control. Studies suggest that approximately 68% of men achieve continence by two months post-operation. This improvement continues steadily, and by 12 to 18 months following surgery, approximately 90% of patients report being continent or having only minimal leakage, often defined as using zero or only one security pad per day.
For the minority of men whose condition persists, the long-term rate of bothersome incontinence generally ranges from 4% to 30%. The most common form is Stress Urinary Incontinence (SUI), the involuntary loss of urine during physical activity like coughing, sneezing, or lifting. Some men also experience Urge Urinary Incontinence (UUI), a sudden, intense need to urinate that results in leakage before reaching the toilet.
Strategies for Managing and Recovering Urinary Control
Recovery of urinary control is an active process that often begins before surgery. Pre-habilitation, specifically involving Pelvic Floor Muscle Training (PFMT), can help patients learn to correctly identify and strengthen the muscles they will rely on after the prostate is removed. This muscle group forms a sling supporting the bladder and is the main target for regaining function.
Post-operatively, PFMT, commonly known as Kegel exercises, becomes the single most important non-surgical intervention. These exercises involve repeatedly contracting and relaxing the muscles that stop the flow of urine, directly strengthening the external urinary sphincter. Working with a specialized physical therapist, often using biofeedback, ensures correct performance and maximizes the benefit of the training.
Lifestyle adjustments can also significantly aid in managing leakage and improving recovery. This includes timed voiding, where the patient attempts to urinate on a schedule rather than waiting for the urge, which helps retrain the bladder. Modifying fluid intake, particularly reducing consumption of bladder irritants like caffeine and alcohol, can decrease the frequency and intensity of urges.
If incontinence remains bothersome despite conservative management and physical therapy for six to twelve months, advanced medical interventions are available. For mild to moderate stress incontinence, a male urethral sling can be surgically implanted to provide mechanical support and compression to the urethra. For more severe cases, the artificial urinary sphincter (AUS) is considered the gold standard treatment, providing a reliable, patient-controlled device that effectively stops leakage. Medications, such as antimuscarinics or beta-3 agonists, may also be prescribed to relax the bladder muscle and address any accompanying urge incontinence.