Table of Contents

Chapter 3: Maximizing Quality of Life After Initial Treatment

a. Urinary Dysfunction

The broad term of urinary dysfunction encompasses many different urinary problems. The most common definition is urinary incontinence, which can range from some leaking to complete loss of bladder control. But there are also more subtle changes that can significantly affect your daily life. These changes, which are collectively known as irritative voiding symptoms or urinary bother, include increased urinary frequency, increased urinary urgency, and pain upon urination.

For men undergoing prostatectomy, incontinence is the primary urinary side effect. Surgical technique plays an important role in determining outcomes; as we discussed earlier, carefully dissecting out the tumor without affecting the urinary sphincter is key. But presurgical urinary function can play an important role as well. If you’ve already experienced some hesitation and/or lack of bladder control, it will be harder for you to regain full control and function.

On average, about 25% of men report frequent leakage or no control and a need to use absorbent pads at six months after treatment; by two years, fewer than 10% report using pads at all. Keep in mind, however, that the definition of incontinence is very subjective, and the degree of incontinence you will experience cannot be determined before you undergo treatment.

External beam radiotherapy can irritate both the bladder and the urethra, causing inflammation or swelling of the prostate. Most of the symptoms lessen over time with little or no intervention: nearly 45% of men report irritative voiding symptoms after six months, and the majority resolve by one year. However, the symptoms can persist in some men, with about 10% of men still requiring medication after two years. Urinary dysfunction following brachytherapy tends to be more severe initially because of the increased trauma to the prostate after implantation of the radioactive seeds. Over 70% of men have symptoms requiring medication within six months after seed implantation, but the rate drops to 25% or less after two years.

Some men might experience spontaneous bleeding into the urine on occasion in the years after radiation. This is because a late effect of the radiation is to cause the blood vessels in the lining of the bladder to weaken and become fragile. If bleeding occurs, it is common for the urologist to check inside the bladder just to make sure that there is not a more important and serious cause of the bleeding other than past radiation therapy. The condition usually stops by itself, but occasionally the urologist might need to perform a minor procedure to close off any troublesome bleeding points.