Table of Contents

Chaoter 3: Maximizing Quality of Life After Initial Treatment

i. Treatment Options

Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow are commonly used. Tamsulosin (Flomax), terazosin (Hytrin), and other alpha-blockers are typically instituted in all men following radiation therapy for at least a few weeks, and are gradually withdrawn as symptoms improve. Note that the oral medications for erectile dysfunction can interact with these drugs, so be sure that your doctors know which drugs you’re taking.

In severe cases, insertion of a catheter or a surgical procedure to remove part of the swollen prostate might be necessary, but improvements in dose planning tend to lessen the possibility of this occurring. As with surgery-related urinary side effects, practitioner skill can play an important role in determining severity and duration of symptoms following any form of radiation therapy.

In cases of persistent urinary incontinence, the least invasive procedure is designed to make the sphincter’s job a bit easier. By injecting collagen into the urethra, the passageway tightens, making it more difficult for urine to leak through. Although over 50% of men stay dry with this procedure, the effects only last for a short time, so it’s not really a permanent solution to the problem.

Longer lasting results are seen with surgical procedures. The simplest procedure is a takeoff on a commonly used procedure in women with incontinence and is based on the theory that the damaged sphincter is not strong enough to withstand abdominal pressure—the pressure builds up, the sphincter gives up, and urine leaks out. A sling made from silicone or, more rarely, human tissue is slipped under the urethra and anchored to the muscle or bone, relieving the urethra from pressure buildup in the abdomen as urine accumulates in the bladder. The sling results in urinary function improvements in about 70% of men after prostatectomy, although only about half of those reported being completely dry after four years. Following radiation therapy, only 30% of men showed an improvement, with even fewer men reporting being completely dry after four years.

The most common complication of the sling placement is a need for tightening of the bolsters that hold it in place, requiring a second surgery. Infection and erosion of the sling can also occur, both of which can also require surgical intervention. Nevertheless, this procedure can be very useful in men who are persistently incontinent after prostatectomy.

About 5% of men who undergo prostatectomy will respond to none of the therapies described above and will remain incontinent. In these men, surgical placement of an artificial sphincter remains the treatment of choice. A cuff is placed around the urethra, and a release button is implanted in the testicle.Until the button is pressed, the cuff remains tight around the urethra and prevents urine from leaking through. Once the button is pressed, the cuff loosens and the urine flows.

Nearly all men who undergo this procedure see some improvement, but only about half remain completely dry and continue to need one or two pads a day. Complications can occur, and surgical revision is sometimes necessary.Yet despite all of this, and despite the fact that it’s an unnatural way to urinate, the vast majority of men who undergo the procedure find that is satisfactorily resolves their need for urinary control.