Urinary Dysfunction After Prostate Cancer Treatment

The term urinary dysfunction includes:

  • Urinary incontinence, which can range from some leaking to complete loss of bladder control

  • Irritative voiding symptoms or urinary bother, including increased urinary frequency, urgency, and pain upon urination

Bladder obstruction caused by an enlarged prostate is the typical reason for these symptoms initially. However, after therapy, they are typically caused by damage to the nerves and muscles used in urinary control.

Following Prostatectomy

Incontinence is the primary urinary side effect. On average, in the hands of a skilled surgeon, about 10-15% of men report frequent leakage or no control and a need to use absorbent pads at six months after treatment. By three years, fewer than 10% report using pads at all.

Up to 30 to 50% of men with normal baseline function will report some increase in urinary symptoms and urgency after prostatectomy. This seems to be reduced if a nerve-sparing technique is performed.

External Beam Radiotherapy

Radiotherapy can irritate both the bladder and the urethra, causing inflammation or swelling of the prostate. Most symptoms lessen over time with little or no intervention: Nearly 45% of men report irritative voiding symptoms after six months, and the majority resolve by one year. However, the symptoms can persist and some men may see an increase.

Following Brachytherapy

Urinary dysfunction following brachytherapy tends to be more severe initially. Over 70% of men have symptoms requiring pads or medication within six months after seed implantation, but the rate drops to 25% or less after two years and to under 10% by three years. However, 20 to 40% of men with normal urinary function at baseline will have persistently increased urinary symptoms three years after receiving brachytherapy.

Management of Urinary Dysfunction

Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow and treat irritative bladder symptoms are commonly prescribed to all men following radiation therapy for at least a few weeks. They are gradually withdrawn as symptoms improve.

In cases of persistent urinary incontinence, surgical procedures, including a sling that relieves pressure buildup in the abdomen or artificial sphincters provide long lasting results.

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