Common Problems Following Prostate Removal - Treating Men's Urinary Incontinence and Erectile Dysfunction
According to the American Cancer Society, approximately one man in eight will be diagnosed with prostate cancer during his lifetime. While many men were originally advised to undergo prostate removal surgery - known as a prostatectomy - today the percentage of men receiving surgery as their initial treatment is dropping (from about 47 percent in 2010, to 31 percent in 2015). This is due in large part to the effectiveness of PSA testing along with the significant side effects associated with prostatectomies - specifically post prostatectomy urinary incontinence and erectile dysfunction.
While the number of men undergoing prostatectomies may be declining, the percentage of men experiencing urinary incontinence and ED following the procedure remains significant. Thankfully, there are treatments available to help alleviate these post-surgical side effects including BTL Emsella, an FDA-approved treatment that tones the pelvic floor musvles and bladder which may have been adversely affected during a prostatectomy, returning neuromuscular control to the pelvic floor and improving urinary continence and sexual function.
About Post Prostatectomy Urinary Incontinence
Following a radical prostatectomy, damage to the urinary sphincter may result in urinary incontinence. During this procedure, the surgeon removes the prostate gland along with one of the valves outside the prostate that opens and closes to let urine out or keep it in. While complete urinary incontinence is uncommon following this procedure (6-8% according to the Cleveland Clinic), most men do experience some degree of urinary incontinence, particularly stress incontinence (the leakage of urine when pressure is exerted on the bladder by sneezing, coughing, exercising, or laughing). Studies show that older men experience higher rates of permanent urinary incontinence following prostate removal surgery compared with younger men.
The incidence of incontinence depends upon its definition, the time elapsed since surgery, and whether or not a nerve-sparing approach was used. Although clinician-reported data indicate that 90 percent or more of patients are continent at 6 to 24 months after surgery, patient-reported data suggest this percentage may be higher.
In a multi-institution analysis of men who had undergone radical prostatectomy, 52 percent of patients reported some urine leakage more than once a day two months after surgery. By 12 and 24 months, this had decreased to approximately 15 percent.
About Post Prostatectomy Erectile Dysfunction
According to Johns Hopkins, “Nearly all men will experience some erectile dysfunction for the first few months after prostate cancer treatment. However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement.” Specifically, about 40-50% of men will have returned to their pre-treatment function within one year and 30-60% will have returned to pre-treatment function after two years, the rates varying depending on the extent of “nerve sparing” a surgeon is able to perform during surgery.
Recovery of erectile function is influenced by multiple factors, including age, pretreatment sexual functioning, and type of surgery (nerve-sparing versus non-nerve-sparing).
Treating Post Prostatectomy Urinary Incontinence
Urinary incontinence typically improves with time following radical prostatectomy, and pelvic floor muscle exercises and physical therapy are often recommended to accelerate the recovery of urinary continence. In our clinic, we use BTL Emsella as a tool to enhance the speed and efficacy of pelvic floor strengthening and recovery. Emsella is a non-invasive, FDA-approved treatment that uses focused, high-intensity electromagnetic (HIFEM) technology to stimulate the deep muscles of the pelvic floor, causing them to contract. A single Emsella session is equivalent to doing 10,000 kegels, serving to re-educate men’s pelvic floor muscles. Most patients report a significant, remarkable improvement in bladder control following a series of treatments, and Emsella tends to produce faster, more significant results when compared to pelvic floor therapy. You can read more about this treatment option here.
Other treatments to consider include:
Behavioral modification (i.e. fluid management or bladder retraining)
Use of pads/diapers
Penile compressive devices (clamps to restrict urine flow - used in severe cases)
Condom catheters
For severe cases where more conservative treatments are not effective (approximately five percent), some men may consider surgical options including AUS (Artificial urinary sphincter), male slings, and periurethral balloons.
Treating Post Prostatectomy Erectile Dysfunction
For men who experience new-onset or worsening ED following a prostatectomy, time and ED pharmaceuticals (i.e. Viagra, Cialis, Trimex) have historically been the only erectile dysfunction treatment options. Our clinic recommends a more comprehensive approach that addresses lifestyle issues, medication options and regenerative therapies:
Pharmaceutical Options:
Oral phosphodiesterase 5 (PDE 5) inhibitors
Penile self-injection (prostaglandin E1, papaverine, phentolamine)
Intraurethral alprostadil
Vacuum-assisted erection devices (while not a pharmaceutical - these are often used in conjunction with the aforementioned medications)
Regenerative Options:
BTL Emsella: BTL Emsella has demonstrated promising results in treating erectile dysfunction following prostate removal surgery. Emsella helps treat ED by strengthening the pelvic floor muscles and improving circulation, leading to increased penile hardness and rigidity as well as enhancing control of ejaculation.
Low Intensity Shockwave Therapy: Shockwave therapy utilizes low-intensity sound waves, stimulating angiogenesis (growth of new blood vessels) and neurogenesis, leading to better and fuller erections.
P-Shot: The P-Shot involves separating out the growth factors in a patient’s own blood, and then re-injecting this super-charged plasma back into their body. The PRP mobilizes local stem cells and growth factors, which accelerate collagen formation, tissue regeneration and the formation of new vascular networks, resulting in increased blood flow to the penis and stronger, more reliable, and more frequent erections.