The prostate is a gland situated in front of the bladder.
In men, the prostate is the main mechanism for urine retention. This is possible thanks to the internal sphincter at the neck of the bladder and the external left sphincter situated exactly past the apex of the prostate, in the pelvic floor.
The prostate may be affected by two pathologies that may cause urinary incontinence as a consequence of the surgeries required to counter them:
Benign hyperplasia and cancer.
Benign hyperplasia is the enlargement of the prostate gland caused normally in middle age and may be due to various hormone-related, genetic and nutritional factors. In the advanced stages of the condition, it obstructs the regular flow and expulsion of urine – in other words, incontinence.
Benign prostatic hyperplasia is treated with medication that consists of medicines that reduce the size (alpha-reductase inhibitors) and medicines that relax the muscle contraction (alpha-inhibitors) of the bladder neck.
In advanced stages, the condition is treated with either open surgery – intravesical prostatectomy – while the most used method is transurethral resection, that may be performed with a type of laser (TURIS).
This technique significantly reduces hospitalization days, reduces haemorrhage during and after surgery and, in general, causes minimal discomfort to the patient.
Where prostate cancer is concerned, the approach taken for treatment is different and depends on the stage of the disease, on the age of the patient and on any co-morbidities.
Surgery, which takes the form of classic surgery or laparoscopic surgical procedures with the help of robots, is the cornerstone of treatment in the early stages of the condition.
A serious issue that results from prostate surgery is urinary incontinence, with rates of 2% in surgery for a benign condition that may reach 10-15% in cases of radical prostatectomy for prostate cancer.
Factors that increase the risk of urinary incontinence following a prostatectomy include puncturing the cartridge of the prostate during intravesical prostatectomy, the co-morbidity of neuromuscular conditions that may affect the contraction and tone of the external sphincter, alcoholism, and diabetic neuropathy.
Kindly contributed by Urologist – Andrologist Surgeon, Dr Charalambos P. Asvestis