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Before prostate surgery, men are still not fully informed about urinary incontinence as a late consequence of the operation. Yet the involuntary loss of urine affects many men despite nerve-sparing surgical techniques. As the German Society of Urology (DGU) published in the current guidelines for the treatment of prostate cancer, at most one in two patients can no longer hold their urine after radical surgery. Quite a few of the operated men suffer permanently from urinary incontinence and are dependent on diapers and pads for the rest of their lives.
Prostate cancer - The diagnosis hits Heinz S. out of the blue. Just 10 days later, the 67-year-old industrial clerk has his prostate gland surgically removed at the city hospital. He then loses control of his bladder function and becomes incontinent. Heinz S. is not an isolated case. "During surgery, a portion of the bladder sphincter often has to be removed. The remaining sphincter is then often too weak to retain 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 urine varies in severity among men who have undergone surgery, ranging from slight loss of urine and wearing pads to permanent use of diapers. In many cases, the symptoms improve again with pelvic floor muscle training or medication. However, in some patients, incontinence remains permanent or begins several years after surgery. In a recent study1 Italian urologists examined the continence status of 235 men who were still able to hold their urine two years after surgery in a long-term follow-up (at least 8 years). The result: 89 percent of the patients remained continent after re-examination and 11 percent of the men used one or more pads daily. This is twice the incontinence rate of non-operated peers. As the researchers report, the higher number of men who no longer have control over their bladders is primarily due to impaired abdominal muscles as a result of the surgery.
Brachytherapy: Less stress on the bladder
"The fact is that urinary incontinence significantly affects the quality of life of those affected," Derakhshani emphasizes. This ranges from general insecurity to the loss of social contacts and activities. Some men even no longer dare to go on vacation or even leave their home for a longer period of time. "It is all the more important," says the Cologne urologist, "to make the patient aware of urinary incontinence as a possible consequence of the surgical intervention in the run-up to the therapy and to include equally effective but gentler treatment procedures such as brachytherapy(internal radiation) in the therapy considerations."
In brachytherapy, tiny radiation sources (seeds) are inserted into the prostate. The mini-implants remain in the gland and deliver high-dose radiation specifically to the tumor tissue over several months. In this way, the tumor is destroyed without permanently damaging the surrounding tissue. "Although a temporary increased urge to urinate may occur after brachytherapy, virtually all patients are spared the dreaded urinary incontinence," Derakhshani emphasizes. In retrospect, Heinz S. is also wiser and would no longer rush into surgery, but would first inform himself comprehensively about the various therapy options with their advantages and disadvantages.