Hi everyone! I'm Alex with PCRI, and we are here to ask your questions to our prostate
cancer expert, Dr. Mark Scholz. He's also our Executive Director. If you have a question
that you would like asked in the future, you can go ahead and email us at Info@PCRI.org,
and for more information visit our website.
Alright Dr. Scholz, today we're talking about leakage. So, effects after prostate cancer
surgery, and this is a huge topic and we're really excited to hear your answers. So, this
is really what do we do about leakage after prostate cancer surgery?
Big problem. The problem with urinary incontinence comes in a lot of different degrees and depending
on how serious it is, there are different solutions. The starting place, of course,
if someone's had recent surgery is to hope that just time will improve the situation
and it will resolve over a period of a few months after the surgery's been completed.
The ways to try and enhance or improve that process is to implement Kegel exercises. That's
a strengthening of the muscle, the sphincter muscle that controls the urine flow. There's
a right and a wrong way to do Kegel exercises and some of the urologists actually do biofeedback—
helping patients learn the right way to squeeze the muscles in a fashion that they build up
their strength and get a quicker recovery. So the Kegel exercises is a starting place
for everybody and they also work for people that develop incontinence when they get older—maybe
they never had an operation—and people can look online and get some more details about
what a Kegel exercise actually is.
The next level, of course, is some sort of medication. There are anticholinergic pills
that can reduce bladder urgency and bring about bladder control in people that have
relatively mild degrees of incontinence, and these are medicines like Enablex, Vesicare,
Myrbetriq. There are other products out there as well, and they can be helpful. They're
not miracle drugs for people with serious incontinence, but they do help people that
have marginal degrees of incontinence, and it's always nice to try a pill and see if
that's going to be helpful—perhaps in conjunction with the Kegel exercises. The problem with
anticholinergics—not Myrbetriq so much, but the other agents—is that they can cause
dry mouth, sometimes issues with fatigue and constipation. So, not everybody tolerates
them super well.
The next level of intensity, of course, is to go visit a urologist and talk about the
placement of an artificial urinary sphincter. This is a surgical procedure where they implant
a small inflatable cuff around the sphincter and this is controller with a switch in the
scrotum, and the sphincter inflates automatically and then deflates for urination by pushing
on a button that's placed in the scrotum. It's a fairly big operation. It's very delicate.
You're working in a previously operated field and so that operation really needs to be done
by doctors that have dedicated themselves to learning that particular operation. It's
not an operation that just any urologist can do. You want to go to a specialist that's
doing this operation over and over, several times a week, has developed the skills to
be able to get good results. Studies seem to indicate that the artificial sphincters
are successful in about 85% of people. So, it's not going to work for everybody, but
the majority of men will get a notable improvement with an artificial sphincter if it's put in
by a skillful doctor.
So, with the artificial sphincter, is that something they'll have for the rest of their
life? Do they have to get parts replaced eventually? Like, how does that work?
Yes, it is for the rest of their life and there is a concern that over a period of years
that mechanical malfunctions can occur and some of these men will be in for another operation
down the line to upgrade it or to fix it, but I've known men that have had them for
over 10 years without really any complications.
Okay, and regarding leakage after surgery. Is there a certain point before Kegels and
all these, you know, options you've talked about come into play? Is there a certain
period where if it they've had surgery and they still have leakage after a certain amount
of them, then this is when they need to start really paying attention to doing these, or
should they do it right after surgery to begin this process as far as Kegels and maybe these
pills?
Yeah, actually some surgeons advise their patients to start the Kegel exercises before
the surgery to build up the muscles and I'm not quite sure how effective that is, but
I do know some doctors are advising their patients to do that.
Can the average everyday urologist, are they aware of these pills and are they pretty standard,
and patients can go talk to them about it?
I think so, yes. It's a super common problem after surgery and so the urologists that are
doing radical prostatectomies are familiar with these steps and I think many of the urologists
are going to be willing to offer an artificial sphincter and think of themselves as competent
to do it, but because it is a tricky operation, I would advise seeking out a urologist that's
developed a dedicated skill just to doing artificial sphincters.
That makes sense. Regarding the tolerance of the pills you mentioned, is there anything
to help mitigate the side effects like dry mouth or any sort of fatigue or anything like
that? Is there anything that the patients can do?
Reduce the dosage, you know, take a smaller amount. Sometimes you can switch to one or
the other products. One, you know, one product may be better tolerated by one patient, but
the level of satisfaction with the pills is not high. I mean, they will help some people
and they're worth a try, but we don't get consistent good results that we would expect
everybody to get better with the pills.
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