Life Begins At.....
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MEN'S HEALTH damaged, the nerves to the area may be damaged, the bladder may change its pressure or elastic characteristics, or the urethra may be damaged. Dealing with urinary incontinence Whilst the chance of incontinence after prostate cancer surgery is less than 10 per cent, for those men unfortunate to have the problem, dealing with it can be frustrating and depressing. Most men have incontinence for a while after surgery, but many are greatly improved by three months after their operation. Before surgery, dealing with factors we know are risks for post-operative incontinence, like chronic cough, smoking, obesity, and chronic constipation, will minimise the chances of problems later. Having the pelvic floor strength assessed, and if necessary, treated before surgery, may be advantageous. Surgical technique is very important when trying to prevent incontinence post-operatively, careful meticulous dissection being crucial. After the operation, early return to normal physical activity and early commencement of pelvic floor muscle rehabilitation is required to restore continence as quickly as possible. Pelvic floor rehabilitation involves actively exercising the pelvic floor muscles to strengthen them and restore the normal reflexes and nerve connections to these muscles. It is best to learn to do pelvic floor muscle exercises before the operation, and physiotherapists and continence nurses are the right people to plan and supervise a pelvic floor rehabilitation programme. Sometimes aids to pelvic floor training may be used, such as magnetic or electrical stimulation of the muscles, but generally well taught, well done, conscientious training of the muscles 92 THE RETIREE SUMMER gives the best results. Pelvic floor exercises should be used for at least six months before deciding that something else will need to be done. If urinary incontinence persists after surgery, or during the time that we are waiting for it to improve, most men will need some sort of continence aid such as male incontinence pads and pants, or maybe external condom-style drainage bags, or penile clamps. The anti-depressant drug Duloxetine may help minor incontinence after surgery, but it must be used with caution because of side effects. Generally though, rather than leave a man to deal with incontinence, we would rather recommend doing something to cure it. Curing urinary incontinence There are surgical procedures that can improve or cure urinary incontinence in men after prostate cancer surgery. The operation recommended would depend on factors such as the degree of incontinence, patient's level of physical activity, mobility and manual dexterity, and also whether other treatments like radiotherapy after the cancer surgery will be required. For very minor incontinence urologists can perform a telescope procedure whereby material in a thick liquid form is injected into the walls of the urethra (water-tube) to "bulk up" the walls and create a better seal to prevent leakage. It is a little like putting a new thick spongy washer into a tap that was leaking, it seals off better and more easily. The results of this surgery however are a bit unpredictable because it is difficult to know how well the walls of the urethra will actually "bulk up" after the scarring and damage from the original cancer surgery. Another procedure for minor – moderate degrees of urine leakage is to surgically implant two small balloons on the outside of the water-tube, just where it joins the bladder, and these balloons, via a valve under the skin, can be filled with liquid to slightly compress the area and also help with sealing off the water-tube. Accurate placement of these balloons can be difficult, and they may move later on, causing incontinence to recur. For most men with ongoing incontinence however, the recommendation will be for surgical placement of a urethral sling (hammock that supports the water- tube), or the implantation of an artificial sphincter device to replace the natural control sphincter. Urethral slings are put into the body via an incision on the perineum (the area between the scrotum and the anus) and two small incisions where the legs join the body. The slings are positioned under the middle of the urethra to either lift and compress it, or lengthen and restore it to a normal position. The success rates vary with how bad the incontinence is, but about 75% of men can be made dry by these types of operations. Possible complications include infection, ongoing incontinence, pain, difficulty passing urine, or erosion of the sling into the water-tube or into the bladder.