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Incontinence after prostatectomy
After radical prostatectomy the leakage is mainly stress leakage from sphincter deficiency; most men improve over the first 12 months with pelvic floor training, and if leakage persists — a male sling for mild to moderate leakage and an artificial urinary sphincter (AUS) for moderate to severe leakage or after radiotherapy.
Why it matters in the exam
The exam shows a man after prostatectomy who wets several pads a day, and asks when and with which operation to treat, or about a complication of an artificial sphincter. Pelvic floor training starts before surgery or right after catheter removal. Surgery is considered only after 6 to 12 months, when leakage is stable. Before surgery cystoscopy is done to exclude a stricture at the bladder-urethra anastomosis, and severity is assessed by pad count or a 24-hour pad test; urodynamics helps when overactivity or detrusor weakness is suspected.
The artificial sphincter is the treatment with the best long-term success in moderate to severe leakage. It has a cuff around the urethra, a pump in the scrotum and a reservoir balloon; the patient squeezes the pump to void, so manual dexterity and cognitive ability are required. Complications: infection, urethral erosion and mechanical failure; with erosion or infection the device is removed. The male sling suits mild to moderate leakage and a patient who prefers a device with no operation by hand, and it is less suitable after radiotherapy. Incontinence after TURP is rarer and treated on similar principles.
An important distinction: urgency leakage after surgery is treated like OAB, and leakage with a weak stream raises suspicion of an anastomotic stricture, which is treated first. A patient after radiotherapy is at higher risk of erosion and infection of an artificial sphincter, and sometimes a double cuff or a different position is used. For some patients who are unfit for surgery a condom catheter or a penile clamp is possible.
Key points
- Most improvement occurs during the first 12 months.
- Pelvic floor training first.
- Cystoscopy before surgery.
- Sling for mild to moderate leakage.
- AUS for severe leakage or after radiotherapy.
Summary table
| Situation | Treatment | Note |
|---|---|---|
| First months | Pelvic floor training | Most improvement by 12 months |
| Stable mild to moderate leakage | Male sling | Less suitable after radiotherapy |
| Moderate to severe leakage or after radiotherapy | Artificial urinary sphincter (AUS) | Needs manual dexterity and cognition |
| Weak stream and leakage | Cystoscopy and dilation of the anastomosis | Before any incontinence surgery |
| AUS erosion or infection | Device removal | Reimplantation later |
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Sources
- AUA/SUFU Guideline: Incontinence after Prostate Treatment, 2024 — Evaluation, conservative and surgical treatment
- EAU Guidelines on Non-neurogenic Male LUTS, 2025 edition — Post-prostatectomy incontinence
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Surgical Procedures for Sphincteric Incontinence in the Male
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.