Urinary leakage, or incontinence, is a frequent side effect experienced by men following prostate surgery, particularly a radical prostatectomy. This occurs because the internal sphincter muscle, located at the bladder neck, is often removed along with the prostate gland. The external sphincter and surrounding pelvic floor muscles must then manage all urinary control. While this complication can be distressing, it is highly manageable and often temporary, with most men seeing significant improvement within the first year after the procedure. Recovery begins with strengthening existing muscle function before considering external aids or, for persistent cases, surgical intervention.
Foundational Recovery Strategies
The initial step toward regaining control involves strengthening the remaining musculature through Pelvic Floor Muscle Training (PFMT), commonly known as Kegel exercises. These exercises target the muscles that support the bladder and urethra, which are now responsible for continence. To perform them correctly, you must isolate the muscles used to stop the flow of urine or prevent passing gas, ensuring that the abdominal, thigh, and buttock muscles remain relaxed during the contraction. Hold the squeeze for several seconds, then fully release and rest, repeating this cycle multiple times a day for consistency.
Consistency is paramount, and many men benefit from consulting a pelvic floor physical therapist who can use biofeedback to ensure the correct muscles are being engaged. Bladder training helps the bladder regain its capacity and function by increasing the time between voids. This technique involves gradually extending the interval between bathroom visits to help retrain the bladder to hold urine for longer periods.
Lifestyle adjustments work alongside these physical strategies to reduce bladder irritation and pressure. Bladder irritants such as caffeine, alcohol, and acidic foods can increase the urgency and frequency of urination, potentially worsening leakage. Maintaining adequate fluid intake is important because highly concentrated urine can also irritate the bladder lining. Preventing constipation through a fiber-rich diet is beneficial, as a full bowel can place additional pressure on the bladder and pelvic floor.
External Devices and Management Aids
While the pelvic floor muscles are recovering, external devices and absorbent aids offer immediate management and improved quality of life. Absorbent products designed for the male anatomy, such as leak guards or male shields, are suitable for light to moderate dribbling. For heavier leakage or maximum protection, protective pull-up underwear or adult briefs provide higher absorbency levels and greater security.
A penile clamp is used for specific periods of time to stop leakage. This device is padded and applies gentle, external pressure to the urethra, closing it off to prevent the flow of urine. It is typically used for short durations during activities like exercise or social outings and should be positioned midway down the shaft. The clamp must be released every one to two hours to allow for urination and restore blood circulation; it should never be worn while sleeping.
The condom catheter is an external collection system attached to a drainage tube and collection bag worn on the leg. This system is useful for men with high-volume leakage or for use during long periods away from a restroom, offering a discreet way to divert urine away from the skin. Proper sizing and application are necessary to ensure a secure fit and prevent skin irritation.
Surgical Procedures for Long-Term Control
When conservative measures like PFMT and bladder training fail to resolve moderate or severe incontinence after approximately 12 months, surgical options become a consideration. The choice of procedure depends largely on the severity of the leakage. For men with mild to moderate stress incontinence, typically defined as using one to three pads per day, the male urethral sling is often recommended.
The male sling involves surgically placing a synthetic mesh material underneath the bulbar urethra. The sling works by slightly repositioning and compressing the urethra, thereby providing support and increasing the resistance to urine flow during physical activities like coughing or lifting. This procedure is less invasive than the alternative and does not require the patient to manually operate a device.
For men with severe incontinence, the Artificial Urinary Sphincter (AUS) is considered the most effective treatment. The AUS is a hydraulic device with three components: an inflatable cuff placed around the urethra, a pressure-regulating balloon reservoir implanted in the abdomen, and a control pump placed within the scrotum. The cuff normally remains inflated with fluid, keeping the urethra closed and preventing leakage. To urinate, the patient squeezes the pump, which transfers the fluid from the cuff to the balloon reservoir, opening the urethra. After a few minutes, the cuff automatically re-inflates, closing the urethra again.