Urinary Incontinence after Radical Prostatectomy | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, MD, talks about urinary incontinence that can be a side effect of radical prostatectomy. He covers the treatments that can help to manage this side effect, from medications to surgical intervention.
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0:44 Why surgery causes urinary incontinence. When the surgery is performed, the prostate is removed and sews the ends of the urinary passage together. When the catheter is removed, men will be incontinent for a few weeks or months for control to return. 5-10% of men will remain incontinent permanently after treatment.
1:55 The two types of incontinence. There are two types of incontinence: Stress incontinence, and overt incontinence. Stress incontinence is where men can retain urine except when they jump, laugh, or cough. This occurs in 50% of men after RP. Kegel exercises can help improve stress incontinence. Anticholinergic medications such as Detrol, Enablex, Ditropan, and Myrbetric can help with this problem as well.
3:15 Overt incontinence is when leakage occurs all the time. In unskilled hands, RP can cause this issue in up to 30-40% of men. Going to a center of excellence can reduce this statistic to less than 10%.
3:42 Treatment for overt incontinence. Surgical intervention is typically required. For milder cases, a sling procedure typically can help solve the issue. If you go this route, ensure that your urologist has experience in this area. Artificial sphincters involve the placement of a cuff around the urethra with a control mechanism implanted in the scrotum. When a man needs to relieve himself, the cuff releases pressure on the urethra and allows the flow of urine. This treatment tends to be highly effective for overt incontinence.
5:03 Other urinary side effects. Climacturia, where men ejaculate urine after RP occurs in about 20% of men after surgery, but this side effect is not mentioned very often. Ensure that you discuss this potential side effect with your urologist before your procedure. A urethral stricture can happen when scar tissue develops in the urethral passage after surgery. This scar tissue can cause a blockage. Treatment for stricture can cause incontinence if the scar tissue is damaged from the treatment for stricture. Thankfully, this only occurs in about 2-3% of men after RP.
6:47 Conclusion. RP is the only treatment for prostate cancer that commonly causes urinary incontinence. Often times with equal cure rates as the alternatives.
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[@stephenhuvane707]

I had Davinci removal of a Stage 1 Prostate Cancer on 9/1/21. I wear depends and a pad and change the pad about 4 times a day. I seem to leak at a low rate all day. The stress incontinence of course is there as well. It’s pretty frustrating but I’m preaching to the choir with you gents. I’m happy that I can now workout with weights the way I did before my surgery. I also have ED but have used aprostadil with good results. The good news. My PSA is undetectable.

[@IsaacAsimov1992]

Thanks for your comment. It’s very helpful and also encouraging. (I had the same procedure as you, September ‘22).

[@brewster102]

Had the surgery in July of 2019. Quickly gained control overnight without leakage. After 8 months I was down to less than 30 grams leakage during the day using pads, but stayed between 30 and 60 grams for the next 20 months. Was considering a sling. I was using a heavy pad inside a diaper to ward off any possible leakage as I am pretty active with stuff like golf and diy projects. Recently I switched to a much lighter shield which is wide enough to handle movement and just using it inside of tight fighting underwear. I am amazed at the smaller amount of leakage I now have, less than 15 grams a day, even days including a round of golf. Underwear stays completely dry.

[@alwayspaul]

My doctor advises wearing the least protection one can get away with. Definitely no diapers... if the body/bladder is given permission to just let go all the time it'll never start holding the pee. Psychologically it's useful to have just a small pad as it encourages the bladder to cooperate.

[@IsaacAsimov1992]

@@alwayspaul This is very interesting. Thanks.

[@Dickie9028]

@@alwayspaul very very helpful. I am three days out after prostatectomy. I sleep all night no urine, I’ll sit in the chair, no urine. Only when I am up and walking the battle starts and I mentally hold it. My goal is psychologically hold it. you have a great point I’m taking this diaper off I am I just walk around with my tidy Whiteys on. But I’m only three days out when I do go to the restroom I measured between 225 and 250 cc of urine that I have held. I think I’ll be OK

[@YEET-kd4en]

My surgery was 01-11-2021 and the incontinence is still improving but very slowly.

[@ricknowak4582]

I hope you get this comment so you can reply. It's 2024. I am 70 years old and I have always peed at least four times per night lately it's been 5 or even 6and even 7! Question. I'm about to get proton therapy and I'm wondering if the radiation will make it even worse!​@@Dickie9028

[@Dickie9028]

Well, I’m only 10 days out of my prostatectomy at MD Anderson. I am doing very well with only one pad throughout the entire day/night . What people must understand is that the comments here are the 10 to 15% of people who develop some form of incontinence. But please remember, that 85 to 90% of people are satisfied with their prostatectomy and living their life to the fullest, cancer free!

[@1nozee]

Thank you for your comment

[@YEET-kd4en]

Fine for you! My case is different.

[@drspaseebo410]

At NO time was I told by my GP, hospital doctors, or the surgeon, that I would suffer urinary incontinence AFTER prostate surgery. It came as a HUGE surprise, very UNwelcome. Now I am left to find a way of handling this gross inconvenience. Am I upset and angry?? YES!!!

[@williamcharnow9038]

all the information is on the Internet--PSA Tests a Scam!

[@waynelast1685]

I found it hard to believe no Dr informed you about possible incontinence problems. That is extreme negligence. I do not believe your story unless you had surgery by some backwoods doctor in some foreign country.

[@thomaslehmann5981]

​@waynelast1685 I believe him I have seen too many arrogant doctors in my time. Especially old bastards.

[@YEET-kd4en]

My surgeon said it was rare and only 5% of the victims had it. But I had it 100%.

[@lewhone6325]

I had RP non nerve sparing surgery two months ago and I am almost back to normal, one pad during the day, none at night. I can see myself returning to normal by the end of the year. It's a small price to pay, for me anyway so far.

[@artmaltman]

Questions please: (1) Do imipramine and/or myrbetriq help with incontinence post-prostatectomy? (2) is incontinence after prostate surgery a random occurrence, a roll of the dice? OR is it due to specific surgical practices such as cutting away too much urethra. Thank you. Art

[@waynelast1685]

I think urethra stricture can still happen if radiation treatment is received?

[@fj2201]

What can men with limited mobility do for incontinence after such surgery?

[@waynelast1685]

Does anyone know about the effectiveness of early detection of cancer recurrence comparing RP to Radiation treatment? I know they can pick up rising PSA levels easily and early after RP, but what about easily enough and early enough after radiation?

[@ThePCRI]

Hello, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

[@gustavmonger]

Excellent information which causes me to pretty much reject RP as an option should I need it.

[@anubis8086]

Kent, sometimes there's no choice, unfortunately. Mine was removed using robotics (Da Vinci), which is supposed to be the very best, and two years later my UI is getting worse. Take care and hopefully you will not need any kind of surgery.

[@gustavmonger]

@@anubis8086 as of last July I have cancer on only the right side which qualifies me on focal therapy. Dr. Scholz just uploaded an excellent video about that. This is far and away the very best web site I have encountered to receive the unvarnished truth about options. I hope it catches on because the current 1210 views of this video should be about 1000 times that amount.

[@martinp3018]

Had mine removed nearly 6 years ago. Best thing I ever did. I know men with far worse side effects from radiotherapy.

[@scott92507]

I have read many articles about this topic, and this is the first I have heard of “overt incontinence.” I have seen only stress incontinence and urge incontinence. Neither seems to describe the situation of overt incontinence. Is this term new?

[@ferdinandblose3379]

Men in other Countries don't go for Surgery because of erectile dysfunction and incontinence. 3 years after surgery still have stress incontinence, not what Dr told me thou

[@greasemonkeybd]

I still have overt leakage 2.5 years after prostate removal and it friggen sucks.I should have had just radiation.

[@williamgrant3999]

@@greasemonkeybd I had surgery and radiation(Now two years of below 0.1 PSA) Still think it's better to get both.The incontinence seemed to get worse after radiation! so am starting an attack dose of Kegels and no Caffeine and plenty of exercise, Small backpack, pads, waterproof underwear is now a fixture. With the surgery, they got rid of most of the cancer, so allowing them to directly target remaining cancer with the minimum amount of radiation (I think)

[@timz8751]

I had all off these side effects with robotic prostate removal at Johns Hopkins and have no improvement after 2 years. In addition I developed Lymphoceles and had an incisional hernia due to surgery that had to be treated. Worst of all I had to have salvage radiation after surgery since the surgery didn’t get all of the cancer. I would highly recommend radiation to avoid side effects. I am mid 60’s; an older person would not have survived all this.

[@ThePCRI]

Tim, thank you so much for sharing your story.

[@vichui9773]

Who was your surgeon?

[@artmaltman]

Thanks for telling your stories. Many of us had our lives destroyed by the surgery.

[@bhavanapatelabsolutelytrue2625]

How are you after five years of your prostate surgery ???and how is your tummy area ? And condition of leaking urine ?????i am just curious to know and understand...

[@brewster102]

Anyone here tried the Emsella chair that works by sending magnetic pulses into the pelvic floor triggering what is claimed to be 1000's of automatic Kegel exercises to the muscles? I have talked to one man who says it helped him immensely--but it is costly and not covered by insurance.

[@ThePCRI]

Hello, we answer question like these through our free prostate cancer Helpline. Please feel free to contact us here: pcri.org/helpline

[@nestordupo845]

I am now in 5 weeks after my RALP and I have severe incontinence change my pads every hr specially when I am walking or exercising, here in Sweden we are lucky because the pads or protection is free or pay a little amount in a yr. And have this aps call tät111 to follow exercise for the pelvic floor mucle. During night time I don't have problems and I can go to the bathroom as normal as before. But this side effect giving me stress and depression because it seems I can not go back to my work anytime soon.

[@YEET-kd4en]

I started with 12-14 pads a day, now I am on 2-3 with very little urine. My surgery was 01-11-2021! It is still getting better, but very slow.

[@englishgardeningsouthernst8723]

I had stress incontinence after RP surgery and that wasn't too bad and i never wore any pads at all. Well, after 8 years i find out my PSA had gone up to the point that my urologist wanted me to have radiation. I had radiation and started having leakage to the point I had to start wearing a pad. Most of the time its not too bad but at times if I'm standing for long periods of time its terrible! Sex, especially after radiation is nonexistent.

[@RH-xd3nx]

If you had a RP ( removal) how do you have a psa count please explain

[@christinamcdonald2819]

I believe that would mean the cancer has returned

[@englishgardeningsouthernst8723]

@@RH-xd3nx That was my question to my Urologist. His reply was “I guess there was a slight bit left”. He didn’t do the RP surgery. Everyone I talked with said to go to Johns Hopkins and have it done, they are the best. Well, evidently not! Also, I don’t understand it taking 8 years for an increase in PSA either. Another problem with JH is I was his third surgery that morning. If I had it to do over again I would have had my local Urologist do the surgery. Also, I should have gotten another opinion when told my PSA was up again.

[@Vincent50]

@@englishgardeningsouthernst8723 This so freaking horrible. They play with our lives.

[@mikejfpax1]

Art, don't know about the meds you mention, but the incontinence is not from cutting away too much urethra, but from the lost of the prostrate that help supported the sphincter of the urethra. I'm going on almost 3 yrs since my RP and still have stress incontinence (wear pads and a clamp) both of which help but are not always perfect. Tried physical therapy with a trained specialist for 6 months provided insight but didn't solve the issue. I'm very active (triathlons, bicycle 60m/weeks and completed 2 marathons since my surgery). I have no ED issues or use any meds and check-ups have PSA is undetectable, I was detected in the very early stages. Still thinking about the male sling just worry about any side effects in the short and long term with my activities.

[@IsaacAsimov1992]

Interesting. I too like to be active. May I ask your age?

[@artmaltman]

Good for you! During activities do you wear a pad or use a clamp?

[@mikejfpax1]

I'm 60 years old. Not that skinny but very active. Completed two individual sprint triathlons this year came in 3rd and 2nd for my bracket.

[@mikejfpax1]

@@artmaltman for the gym I can wear both or just a pad. I use Tena pads level 3 or 4s. For running and cycling only a level 3 pad. Depending on the amount of fluids I have and sweat i can by with one pad on a bike while riding its when i get off it flows. For running i get by with one usually becase i sweat alot

[@artmaltman]

@@mikejfpax1 Periodically I find it incredibly depressing. Does that happen to you and how do you deal with it?

[@jimbrew4529]

Prior to surgery, my Mayo doctor stated I'd be continent again in 4 months. I thought that's a rather bold statement, but okay. After 3 months, I'm thinking he was probably correct.

[@justentertainment8684]

There are several ideas for treating bladder control issues naturally Try Kegel exercises- which involve flexing the same muscles you use to stop the urinary flow.Try losing weight if you are overweight excess belly fat puts pressure on the bladder and the pelvic muscles. Shedding a few pounds if you are overweight can help restore your bladder control.Try to train your bladder - put off going to bathroom. Try to delay urinating by 10 minutes and build up to 20 minutes etc.Use magnesium and vitamin DTry Quiting smoking. Nicotine can irritate the bladder.(I discovered these and why they work on Nilah Control Plan site )

[@IsaacAsimov1992]

Very helpful suggestions. Thank you.

[@zanasaratlija8114]

Dear doctor antimuscarinics can not help men with stress incontinence only with urgency incontinence

[@brunyjacob4456]

I had the procedure done April 10Th, 2019 and they removed the catheter April 17TH, 2019. I am 44 years old, no other medical complications besides the prostate cancer. I was able to maintain 100% urinary incontinence that day. My surgeon told me it's very rare almost impossible to see case because every one had experienced some forms of incontinence. The surgery was nerve-sparing on both sides, what are the chances of me regaining an healthy sex life as I am going through the recovery period? Thank you !

[@bamnibaum]

What I was told that it all depended on how my erections and sex life was before surgery. The truth? At 65 years old, no matter what people think you're not a Cassanova anymore. You're told at 65 a man should have a hot, active sex life. This is far from reality. You might need a little help even at a younger age, maybe some Cialis or Viagra. After your surgery the spirit might be willing but the tool won't crack the nut!

[@rjc128]

Where did you have your surgery done?

[@brunyjacob4456]

@@rjc128 VA hospital in Boston.

[@stephenhuvane707]

If I can ask you, has your sex life resumed? I went through through the same surgery you had (9 months ago) and erections without injections are non existent. Thanks.

[@brunyjacob4456]

@@stephenhuvane707 I don't know how old you are but for me I am under 50 so I am able to have an erection but I take 1/4 of a viagra pill. Without it, I still have a solid erection but only lasts 10 minutes.

[@johnfreeman1164]

This is the reason that I had proton radiation therapy instead of the surgery for my prostate cancer.

[@syedhyder1905]

Then what is the best option, Surgery or radiation for a low grade prostate cancer ?

[@Rikki-lh2mw]

Please brother Try any options apart RP surgery operation! Please.... I had one so since then my life became a hell. Hernia Leaking Tummy pains needles pins. Penis will be shorten of 1 to 2 inch Your life will be changed completely.

[@bradbredin9323]

@@Rikki-lh2mw I’m 64 good health. Psa 7 Gleason 8. I have to make a decision for prostate removal or radiation. It seems like both options are successful. Less complications with radiation. My urologist wants me to speak with a radiologist before deciding…….all the best to us both…..

[@Rikki-lh2mw]

@Brad Bredin You are lucky that you have been given options! Nobody given to me any options, they even tried to do everything to convinced me that I had a prostate cancer when I didn't have it!! I seen many doctors, medicals before had to surgery!Stupidly I trusted them I tell you why I had to go ahead with the surgery!! Because of I have been taking other medicines those made me not to think about it properly!! All the doctor's used same language they said ,,hello I believe that you have a cancer! Even I told them that I wasn't in a pain.I wasn't getting up night times for toilet duties, day times I was managing not to use the toilets half days!! Anyway I let them destroy my life. Please do not chose the surgery option mate if you do than remember this...its not the surgery it's the complications after the surgery. Top of that forget the sex life Your penis will be shortened 1-2 inches. Pains of adhesions will be there rest of your life Rest of your life you will need to do public floor exercise . Never mind kidney infections or use of cather problems etc. Good luck and please let us know about your situation in the future.thanks Ps.your age is a good age you will still need to have a healthy bedroom life.

[@darrenwasylyk7857]

@@bradbredin9323what did u choose?

[@artmaltman]

I thought that radiation causes incontinence after several years, no?

[@jeaneroller4938]

My husband had laparoscopy prostate surgery 14 years ago. He probably should have waited. He has incontinence that has affected his quality of life. The nerve sparing surgery is sometimes useless as it really depends on how much damage they do to the nerves. We weren't really told this was the issue that sparing them just wasn't good enough. Make sure to do your research. He was in his mid 50's. Also, be aware that you may be more prone to heart issues once you have your prostate removed.

[@bamnibaum]

The Heart Problems might be because of Stress that you aren't informed about. Stress because you might wet yourself, and stress because your penis shrinks and won't get erect anymore for sexual intercourse. In the end all this stress will give you problems. Don't get the bladder sling that the Urologist will offer to cure the incontinence. It does not help!

[@jeaneroller4938]

@@bamnibaum Yes, all those things you mentioned can occur and do occur more frequently than they will ever admit to as they are not honest as they don't want to scare men off from having the procedure as it would severely cut into their profits but heart disease is a very real outcome of prostate removal especially with hormone treatment. Yes, the bladder sling does not work for most men. It is just another money-making venture on the medical train ride into hell.

[@jeaneroller4938]

@@justdoesntaddup8620 I agree. It is a shame that butcher so many men with these surgeries. The informed consent and information is not true. Men need to be better educated as to what will really happen.

[@artmaltman]

@@justdoesntaddup8620 The relentless incontinence and ED has me considering suicide often. The benefit of the surgery was not worth the cost in health.

[@IsaacAsimov1992]

@@artmaltman If you haven't done so already consider joining a support group where you can meet with other men regularly and share your stories.

[@Dickie9028]

The complications of radiation was just a little too scary for me. Walking around with a hand grenade for the rest of your life under your balls. I decided to have the prostatectomy. I’ll take my chances with incontinence. To each its own decision.

[@Vincent50]

I’m with you. The thought of a catheter in me for so many days scare me for I’ve never had that experience but the surgery it will be. I’ll deal with the side effect and all and keep in prayer. Radiation side effects is much too scary. I’ve talked actually to two men and the other I was told are all doing good having had the surgery. Three I know had radiation but only one I talked to and he had to stop the hormone therapy where he said it was the worst but the radiation was no problem.

[@ricknowak4582]

​@@Vincent50I am planning on taking proton therapy but I am going to refuse all hormone treatments! Mark Schultz had a video 3 months ago regarding this matter. Cleaning that lowering testosterone is a bad idea! Recently I have found a few other doctors saying the same thing. Just mind bogging that the date can't figure this out yet! There can always coming out with new ADT treatments! Second generation third generation. What The other ones didn't work then? Very frustrating.

[@Vincent50]

@@ricknowak4582 I see my response was 8 months ago but so much has changed. I decided to go with radiation instead of surgery. I got my first ADT shot in December 2023 and started radiation treatments the first of February for 44 days. I am happy to say I had minor side effects with only the incontenance going on. Fifteen minutes a day and I was up and out. I continued to work and not miss a beat with my everyday life. Now the ADT therapy the side effect I feel the most is those hot flashes. The worst but other than that I'm doing and feeling well. My PSA test shows my numbers went down so much. I got my second ADT shot last month in June. The hot flashes are ugly but I manage. I'm a sweater anyway so this only adds to it. I'll see my Oncologist next month and from there I'll know what to do ongoing. I'm still managing my diet which is the hardest for me because i LOVE FOOD and my goodies but slowly eliminating them and watching my intake very closely adding more veggies. I'm keeping in my prayers that I will get better with time. You do what you have to for you that's all that matters. I've researched as much as I could but very glad of the choice I made for its working for me.

[@greasemonkeybd]

why y'all never answer any questions??

[@ThePCRI]

Hello Jeff, due to the complexity of each prostate cancer case and question, PCRI answers questions through our free Helpline. Please feel free to contact us here: pcri.org/helpline

[@artmaltman]

@@ThePCRI The help line is fantastic. Don't hesitate to call them.

[@cylekeltner1261]

I had a 7. Divinci removal. After catheter a pad was needed only two weeks. Been on year. The boner is back! Lol. I take Supplement called Redwood for blood flow and Fadogia and yongot to boost testosterone. I was worried telling you...a year after and I piss better than I did previous 3 years. The boner I didnt expect it wood lol come back after so much time. But seems when I started those supplements it came around quick! Was a good decision for me.

[@Dickie9028]

That’s what I’m talking about, thank you for coming back and giving the good news. I think there are more positive news than bad news. Incontinence only happens 5 to 10% post surgery. I’m three days out at night no urination, when I sit no urination, only use a 1 pad daily and only have a small amount of leakage while I’m up and standing. I think I’m going to beat this too.

[@ctotheb7775]

"I'm not a urologist." ???😳

[@suckafatone]

If I'm one of the guys that dont get my control back I'm a dead man. Not living in a diaper at 49 years old. Good luck everyone

[@brianrowe236]

70 yrs old. Had my da vinci prostate removal 7 months ago. Incontinence was my biggest worry. Other than the first hour or so after the catheter was removed, it hasn't been a problem. I wore pads as a precaution for the first month but haven't bothered since. On the very occasional day, a minimal stress incontinence, a drop or two at the most, but one learns quickly what to avoid doing. My surgeon said that most of his patients have full continence within the year. I must confess that I never kept up with my kegel exercises. My wife and I independently toured China a month before the op as we thought it might be the last chance to do so. I hardly gave the op a thought whilst we were there, hence a lack of kegel excercises. We went back to China last November and nothing had changed. Except that I was cancer free.

[@ThePCRI]

Hello Michell, the PCRI Helpline may be able to help with some suggestions to help mitigate the side effects. Please feel free to contact us here: pcri.org/helpline

[@waynelast1685]

Do you realize how difficult it is for the surgeon to cut out your prostate without damaging surrounding nerves and tissue? Unfortunately every man is different I think. I am sorry for your situation . I hope you can get some help about it and make some positive adjustments in your life. Life is still worth living and their is a lot to look forward to. You have to stay focused on that.

[@IsaacAsimov1992]

@@waynelast1685 Thank you !

[@ferdinandblose5922]

What message are you sending to prostate cancer patients. You suppose to give advice. You mean nobody must treat cancer because of 100% incontinence.

[@tommac21]

I'm sorry. But I'd rather make my funeral arrangements. This doesn't even seem like it's worth life.

[@nyfan9215]

Nope, I'd rather do radiation or even cancer death rather than incontinence.

[@MDHS1979]

I had my prostate removed 17 months ago and have been badly incontinence since. Yesterday I had an artificial sphincter put in. In six weeks I will have it activated. Hopefully it works.

[@anthonymiller6081]

After hearing this side affect of incontinence after prostate surgery it certainly turns me off having any surgery. I have to have a biopsy to determine if I have cancer and I'm really hoping and praying I don't. I would really hate to have to go through all these side affects. I've read via google search that there's a very high percentage of patients who only suffer brief incontinence and return to normal voiding eventuates

[@leongasperment3343]

you will see so many different opinions on side effects after surgery