Urinary Dysfunction

The term of urinary dysfunction encompasses both urinary incontinence, which can range from some leaking to complete loss of bladder control, and irritative voiding symptoms or urinary bother, including increased urinary frequency, increased urinary urgency, and pain upon urination.

For men undergoing prostatectomy, incontinence is the primary urinary side effect. 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.

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. 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 form of urinary dysfunction is normal following initial therapy for localized prostate cancer. But it’s important to realize that not all symptoms are normal, and that some require immediate care. See When To Seek Help for a review of what to do if the symptoms do not improve or worsen over time.

Management of Urinary Dysfunction

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are typically instituted in all men following radiation therapy for at least a few weeks, and are gradually withdrawn as symptoms improve.

In cases of persistent urinary incontinence, the least invasive procedure consists of an injection of collagen into the urethra. This tightens the passageway, 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.

Longer lasting results are seen with surgical procedures. In this procedure, 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.

Additional Reading:

Chapter 3: Maximizing Quality of Life After Initial Treatment: Urinary Dysfunction

Chapter 3: Maximizing Quality of Life After Initial Treatment: Urinary Dysfunction Treatment Options

Prostate Cancer News: Treatment and Outcomes