As with many surgical procedures for malignancies, prostatectomy may resolve prostate cancer but it brings with it a number of postoperative sequelae, such as stress urinary incontinence (SUI) and pain. Interestingly, although the possibility of sexual dysfunction may loom large among many potential patients, incontinence is one of the most feared complications of a prostatectomy, according to the authors of a recently published review.1 This fear is not unfounded; 5% to 20% of patients will experience some degree of incontinence for up to 2 years after their prostatectomy, although it decreases as time goes on.1
Doctors have treated prostatectomy-related incontinence with methods that begin with educating patients to make simple lifestyle adjustments. They may move on to pelvic floor muscle training (PFMT) that might include biofeedback. However, if those modalities prove ineffective, oral medications, extracorporeal magnetic innervation, external pelvic compression devices, injectable bulking agents, and surgical implantation of a male sling or artificial sphincter are other therapies that may resolve the patient’s incontinence.
Muscle Function and Incontinence Type
Pelvic floor dysfunction (PFD) manifests in 3 types: underactivity or weakness; overactivity, which is tightness or muscle spasm often with muscle shortening; and dyssynergia, abnormal coordination with inappropriate or poorly timed movement.
Pelvic floor muscle training is a type of physical therapy that works to normalize pelvic muscle function. Prostatectomy causes a loss of urethral closing pressure, and pelvic floor muscle training teaches the patient how to use Kegel exercises for strengthening to counteract that. This technique is most effective at improving weakness. The authors note that pelvic rehabilitation practitioners now aim to avoid the one-size-fits-all approach that would apply to patients with almost any diagnosis, which was popular in the past. Current practice is to first normalize each patient’s pelvic floor dysfunction and then work on improving their incontinence and reducing postoperative pain.
All the authors of this study are affiliated with University of Texas (UT) Southwestern Medical Center in Dallas, Texas. Their premise was that Kegel exercises alone may not work for some postprostatectomy patients with stress urinary incontinence. For example, if the type of PFD is overactivity, not underactivity or weakness, the muscle is tight; exercises would make it even tighter but not stronger.