Post-prostatectomy continence rates aren’t an exact science… but science can potentially provide patients with better outcomes.
A major concern for men following a successful radical prostatectomy is when they will regain urinary continence. Prior to a prostate cancer diagnosis, urination is a bodily function that many men take for granted. Post-surgery, however, urinary leakage and lack of control is a source of frustration, embarrassment, and even depression.
Facts to know before your surgery
Continence rates aren’t an exact science… but science can provide patients with better post-operative outcomes. Minimizing nerve damage to the pelvic area during a radical prostatectomy procedure gives the best chance at a positive outcome post-recovery. ProPep’s Nerve Monitoring System, provides the surgeon with nerve location and potentially allows the surgeon to leave more nerves undamaged. In fact, all surgeons surveyed – who actively use nerve monitoring – report better patient urinary continence recovery. It is normal for a man to expect a certain level of incontinence as he recovers from surgery, but most men expect to have fully recovered urinary and sexual function within six to eight months. Unfortunately, this is not always the case. These days, patients have to be prepared to stand up for the quality of life they expect after surgery, and that often means advocating for their surgeons to use every tool available to ensure the best outcome.
From misleading statistics to realistic expectations
Mark Twain may have said it best: “There are three kinds of lies: lies, damned lies, and statistics”. In this case, statistics can lead many men to unrealistic expectations for their post-operative recoveries. Unfortunately, many of these continence rates are relayed by surgeons are their own subjective measures of success for their patients. Men should be made aware that the statistics they are hearing about may not be the reality of their situation, and unrealistic expectations may lead to disappointment, frustration and even depression.
When discussing prostate cancer, matters are further complicated by the fact that patients define continence as using no pads per day, whereas urologist-defined continence can be anything from 0, 1, or even 2 pads per day! Reports that give figures for continence, but don’t define continence, should be read bearing this information in mind.
Additionally, radical prostatectomy surgery cannot perform urinary function miracles. If a man already experiences leakage prior to surgery, this will not be corrected during the surgery. A man’s pre-operative urinary (and sexual) function should be his own benchmark.
What to expect immediately after surgery
After a prostatectomy, a catheter is fitted and a bag attached to the patient’s leg. Patients typically use it for up to a week after the surgery, at which point it is removed. During these first few days, it’s normal to urinate more (drinking more is recommended) and the urine may at times be light red or pink. Surgeons typically suggest that the important thing is to make sure the bag is filling correctly. You may be on pain medication for a little while and even suffer from constipation or swelling. All these side effects are completely normal. Your focus in the first week after surgery should be on resting and healing, rather than regaining urinary function.
What you can do
Aside from making the most appropriate treatment choice for your particular situation to begin with, surgeons oftentimes recommend doing Kegel exercises before and after your prostatectomy as an effective way to improve continence. It is important to note that they should only be continued post-surgery after your catheter has been removed.
Kegel exercises strengthen pelvic floor muscles and should be done while sitting to be most effective. They involve squeezing your pelvic floor muscles (as if to stop your urine flow mid-stream), holding them for a few seconds and releasing them. For a full description, consult the Mayo Clinic. Oftentimes, surgeons say that it’s a good idea to start doing Kegel exercises prior to your surgery in order to get a head start on strengthening those muscles.
Above all, remember: your body has just undergone a surgical procedure and it needs time to heal. Do not underestimate the importance of having realistic expectations, which you can discuss with your urologist, based on your pre-surgery index scores and the technology that is used during your surgery. Be sure to rest appropriately after your surgery and resume your Kegel exercises as soon as your urologist allows.