Robot-assisted radical prostatectomy appears to provide better functional results for incontinence and potency, according to the authors of a study from Turin, Italy.
First author Francesco Porpiglia, MD, of San Luigi Gonzaga Hospital-Orbassano (Turin), University of Turin, and colleagues studied 120 patients with organ-confined prostate cancer who were randomly assigned to one of two groups of 60 men based on surgical approach: robot-assisted radical prostatectomy or laparoscopic radical prostatectomy. All interventions were performed with the same technique by the same single surgeon.
Demographic, perioperative, and pathologic results were recorded and compared. Continence was evaluated at the time of catheter removal and 48 hours later, and continence and potency were evaluated after 1, 3, 6, and 12 months.
No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the robotic prostatectomy group at every time point: continence after 3 months was 80% in the robotic surgery group and 61.6% in the laparoscopic surgery group (p=.044), and after 1 year, the continence rates were 95.0% and 83.3%, respectively (p=.042), as reported online in European Urology (July 20, 2012).
Among patients who were potent preoperatively and treated with nerve-sparing techniques, the rate of erection recovery was 80% and 54.2%, respectively (p=.020).
Urinary incontinence is more common than reported. Regrettably, many people suffer in silence and restrict their daily activities. Yet incontinence is often easily managed and treated, indeed, experts have shown that nearly 80% of people with poor bladder control can be cured or improve.
Bladder control is a problem for women and men, and some young people. Experts estimate that four out of five incontinence patients are women — especially those who have had pregnancies or who are elderly.
Urine leakage is the symptom of a medical problem. Diabetes, strokes or Parkinson’s can damage nerves. A bladder infection or irritation (like a kidney stone) can scar the urethra (the tube that moves urine from the bladder). Childbirth can weaken muscles, stretch tendons, or damage nerves. Drugs like diuretics can increase bladder activity. It can be hard to get to a toilet if severe arthritis slows walking, or if medication makes a person confused or sleepy. Lower estrogen during menopause can weaken the vaginal canal.
There are several types of incontinence. Stress incontinence occurs when pressure on the bladder causes a loss of control and leakage. This often occurs when a person sneezes, laughs, falls, runs, exercises or lifts a heavy object. Urge incontinence is different; the bladder becomes overactive, perhaps from a spasm. The sudden urge to go makes a person rush to the toilet. Overflow incontinence can occur when the bladder will not empty and urine builds. Something might prevent the bladder from emptying, such as constipation, an enlarged prostate, or scar tissue.
Pelvic surgery and trauma can affect the nerves, muscles, and structure of the pelvic area.
For women, the trauma of childbirth and carrying a baby can reduce support of pelvic organs, affect the bladder, and injure nerves. After a pregnancy, weak muscles can also cause the bladder or uterus to drop out of place and bulge into the vaginal canal or press down on the rectum.
For men, especially older men, an enlarged prostate or prostate surgery can weaken muscles or cause nerve damage. The surgeon might widen a passage for urine or use techniques to shrink an enlarged prostate gland. Men can need surgery for prostate cancer. At times, surgery results in complications such as impotence or incontinence
There are many urological tests that can help specialists learn the specific problem or problems causing leakage. Urodynamics tests are helpful to see how efficiently a bladder fills and empties.
However, don’t assume that incontinence is a problem that you must just accept.
Don’t be embarrassed to get help. Specialists (urologists for men and women, or urogynecologists for women) can do tests to pinpoint medical problems. Finfing the right solution depends on identifying the real problem.
Don’t be afraid to be honest with your doctor or nurse, give a complete history so they have all the information to make a correct diagnosis. Don’t be surpised to be asked for a physical examination and to provide a urine sample.
Look for habits that you can change to manage leakage. Some people improve by avoiding caffeine, alcohol and certain drugs, and by limiting fluids at night before bedtime. A diet of fruits, vegetables and whole grains can reduce constipation. Drink enough fluids in the daytime to avoid urinary tract infections and constipation.
If you weigh too much, lose weight. A large belly puts pressure on the pelvic muscles. Excess weight can cause both stress and urge incontinence.
For urge incontinence, create a regular schedule to empty your bladder, starting at every two hours. Over time, you can increase the time between trips to the bathroom. This schedule can retrain your bladder to control urges.
Regardless of your age or sex, force yourself to do Pelvic Floor (Kegel) exercises. They can strengthen muscles to support the bladder and control leakage. Don’t just blame old age or being out of shape for your poor bladder control.
If you are a young woman, start doing Kegel exercises before getting pregnant. Strong pelvic muscles will serve you throughout your life and could make the effects of childbirth less difficult.
Marc Bourgeois, 48, says urinary incontinence was one of the most frustrating and embarrassing things he has dealt with in his life—but that doesn’t prevent him from talking about it with other men.
“If I can prompt just one man to seek help for his urinary incontinence, it was worth it because it is most often very treatable with the right doctor,” says Bourgeois. “I’ve been amazed by how many men I’ve encountered who have trouble with urinary continence since sharing my experience.”
In February 2012, Bourgeois began experiencing unusually high urinary frequency in the middle of the night. This progressed to complete loss of control over his bladder while he slept.
“I’d wake up soaked four to five times a night. I started wearing Incontinence Pants and avoiding water six hours before going to bed to try and prevent it. It caused me extreme anxiety,” he recalls. “It came on gradually and I was so caught up in the business of life that I wasn’t paying attention to the signs my body was sending.”
Those signs included a weak urine stream and overall reduced urine output. He was referred for additional testing to Ayman Mahdy MD, PhD a UC Health urologist, assistant professor at the UC College of Medicine and the director of voiding dysfunction and female urology. Mahdy is fellowship trained in urinary incontinence, voiding dysfunction and female urology. Mahdy prescribed a bladder scope test (cystoscopy) and a comprehensive video-urodynamics examination to fully assess Bourgeois’ bladder and kidney health to determine the best course of action.
Tests revealed the underlying source of Bourgeois’ incontinence: a blockage in his bladder, caused by an enlarged prostate. He was diagnosed with chronic urine retention with reflux. This chronic retention had caused resulted in “overflow” incontinence, which indicated further imaging and kidney function evaluation. Tests showed long-term pressure from the backup of urine had resulted in a distended bladder and stress on his kidneys that had severely compromised his left kidney health. During testing, Mahdy’s team removed a large quantity of retained urine from Bourgeois’ bladder.
“I had to self-catheterize until they cleared me for surgery. It was one of the hardest things I’ve ever done, but the Kristy (nurse) was so patient and coached me until I got it right,” recalls Bourgeois.
Back pressure is detrimental to the kidneys—it causes the organ to lose its ability to function normally. It was critical that we remove the bladder obstruction right away to reduce the pressure on Mr. Bourgeois’ kidney to preserve his remaining kidney function,” explains Mahdy.
Bourgeois underwent a transurethral resection of the prostate—known for short as a “TURP procedure”—to remove the blockage in May 2012 at UC Health West Chester Hospital, in the USA. By 10 a.m. the next day, Bourgeois had his catheter removed and was able to spontaneously and completely empty his bladder. He didn’t need the catheter anymore to eliminate urine from his bladder effectively. Within a week, he had completely regained control of his bladder.
“My prayers—and my mother’s—were answered when I found Dr. Mahdy. Because of him, I can have a normal life. I have reset my life in many ways, and I hope other men realize through my testimonial that they don’t have to suffer in silence from urinary incontinence.”
- Two-thirds of individuals who experience loss of bladder control symptoms do not use any treatment or product to manage their incontinence. 1
- Urinary Incontinence affects 200 million people worldwide. 1
- One in four women over the age of 18 experience episodes of leaking urine involuntarily. 1
- On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s). 1
- Stress urinary incontinence, the most prevalent form of incontinence among women, affects an estimated 15 million adult women in the U.S. 1
- Pregnancy, childbirth, and menopause are major reasons of the increased prevalence of incontinence in women as compared to men. 1
- Between the ages of 18 and 44, approximately 24% of women experience incontinence.3
- For women over age 60, approximately 23% deal with incontinence.3
1 National Association for Incontinence, Facts and Statistics, http://www.nafc.org/index.php?page=facts-statistics
2 WomensHealth.gov, Urinary incontinence fact sheet, http://womenshealth.gov/publications/ourpublications/fact-sheet/urinary-incontinence.cfm
3 American Medical Systems, Urinary incontinence, http://www.americanmedicalsystems.com/womens_conditions_detail_objectname_womens_urin_incont.html
A ‘nerve-spotter’ is being tested as a way to reduce nerve damage which can cause incontinence following surgery. The device detects the location of crucial nerves buried in the tissue and invisible to the eye, thus enabling surgeons to avoid accidentally severing them.
Doctors are now trialling it in prostate surgery to reduce post-operative incontinence and impotence. It’s estimated that around 30 per cent of prostate cancer patients suffer some degree of erectile dysfunction after a prostatectomy (prostate gland removal). This is usually a result of damage to two sets of nerves next to the prostate gland, one set of which controls sexual functioning and the other continence. In some cases, these side-effects are temporary, but in around 20 per cent of patients they can last for up to two years or longer. Many men will use male incontinence pads during this period.
At the moment, surgeons have relatively unsophisticated ways of avoiding the nerves, relying on anatomical ‘signposts’ such as the seminal vesicles (tiny sacs at the back of the prostate gland) and their judgment, however the problem is that these markers vary with each man.
The new device, called the ProPep Nerve Monitoring System, helps the surgeon monitor the position of the nerves. Two wire-like electrodes are placed in the tissue around the prostate and urethra (the tube that carries urine from the bladder) and these electrodes are connected to an external monitor.
The electrodes emit a small electrical current and the speed at which this current passes through the tissue shows if there is a nerve there as nerves, unlike tissue, are highly efficient carriers of electricity. When nerves are detected, the electrodes produce a warning signal, displayed on the monitor for the surgeon to see during the operation.
‘Surgeons welcome anything that will help pinpoint the nerves to give better outcomes for sexual function and continence,’ said Professor Raj Persad
Fashionable tight-fitting jeans can cause bladder weakness and long- term health consequences, medical experts have warned. The uber-cool skinny denims, favoured by celebs such as Russell Brand, Jude Law and Joey Essex can increase the risk of urinary tract infections and in some agonising cases, men can even suffer with twisted testicles.
A study of 2,000 British men, conducted by TENA Men, the leading male incontinence brand, has revealed that 10 per cent of men have experienced an unpleasant side-effect as a result of wearing skinny jeans.
Dr Hilary Jones, TENA Brand Ambassador and campaign spokesperson, said:
“Men who wear tight or ill-fitting trousers or underwear which is restrictive around the groin area could be damaging their health.
“Wearing tight-fitting clothing over a prolonged period of time can lead to urinary tract infections leading to over-activity of the bladder- a type of bladder weakness as well as a low sperm count and fungal infections.
“I have seen several cases of men who have twisted their testicles due to wearing jeans that are far too tight.
“My advice would be to make sure you leave plenty of room around the groin area and that your pants and trousers feel comfortable so you’re not being restricted in any way.
“Please don’t put style before health.”
Tight-fitting jeans around the groin area can put additional pressure on the bladder but can also lead to bacteria breeding and re-entering the body causing urinary tract infections; this increases the need to urinate more frequently and can cause severe pain. Of those men suffering from skinny jeans, half had experienced groin discomfort, over a quarter had bladder troubles and one in five suffered a twisted testicle. Worryingly, one in four regularly squeeze into jeans- with the biggest reasons given for enduring tightness being ‘to show I can still fit in them’ and ‘because they look good.’
In fact, three in ten has suffered discomfort from tight jeans and 40% of men admit they sometimes sacrifice comfort over style. One in seven British men regularly wear skinny jeans, but more than a third confess they don’t actually know their correct jean size, whilst when it comes to picking jeans, just 7% described softness and comfort as an important factor.
Zoe Brimfield, TENA Men Brand Manager said:
“With this survey we were keen to highlight that while men may like the look of tight-fitting jeans, it’s important that they are not compromising their health. Wearing skinny or ill-fitting jeans can lead to bladder weakness as a longer-term consequence. Male bladder weakness is more common than people think, with 1 in 9 men in the UK currently experiencing some form of the condition.”
Of patients who undergo radical prostatectomy 5% are expected to be treated with surgery for urinary incontinence during a 15-year period claims a new study from Canada.
The population based study covered 25,346 men who underwent radical prostatectomy for prostate cancer in Ontario, Canada between 1993 and 2006.
The study also discovered that rates of subsequent surgery for urinary incontinence doubled between five and 15 years after the first operation.
The study, published in the Journal of Urology, is the first to suggest that urinary incontinence may be a long-term problem for men many years after their prostate surgery, according to the researchers.
According to Prostrate Cancer UK, one in nine men will get prostrate cancer, the most common cancer in men in the UK. Over 40,000 men are diagnosed with prostate cancer in the UK every year and a quarter of a million men are currently living with the disease.
Male Incontinence is one of the main side effects of prostatectomy with about a large proportion of men reporting frequent leakage or no bladder control after the operation. Men find they often need to use incontinence pads such as TENA Men up to six months after prostatectomy, however the need for pads and the level of abosrbency required generally decreases over time and by three years, less than 10% of men report using incontinence pads.
A recent article in the Daily Mail highlights a new technique called 4D brachytherapy that is available on NHS to treat prostate cancer. This new form of prostate cancer treatment has been devised by British surgeons and only takes half an hour. The technique is just as effective as surgery but is cheaper and has fewer side effects. This means men are back on their feet and back at work sooner and are much less likely to suffer problems such as impotence and incontinence.
The treatment, pioneered at the Royal Surrey County Hospital in Guildford, is a more advanced version of brachytherapy, a technique which has been used successfully for more than a decade. Brachytherapy, used on men in the early stages of prostate cancer as an alternative to conventional radiotherapy or surgery, consists of radioactive ‘seeds’ which are implanted into the prostate gland to destroy the tumour from inside. This targeted radiation means higher doses can be used than in traditional radiotherapy and also helps to ensure the bladder and surrounding tissues are not damaged.
It also has fewer side effects than prostate removal surgery – a major operation which can involve days in hospital and weeks off work. Surgery also often causes male incontinence and leaves up to 80 per cent of men impotent. Brachytherapy usually takes around three hours but the team have refined it to take as little as half an hour without losing any effectiveness.
Surgeons use a two-minute scan to take five key measurements of a man’s prostate. These are fed into a computer programme which uses information from hundreds of previous operations to work out how many seeds are needed and where they should go. Up to 120 seeds, each the size of a grain of rice, are then inserted into the prostate in an operation that takes between 30 to 40 minutes. Patients are often discharged on the same day and return to work within 48 hours.
Some 83 per cent of men remain potent, more than both surgery and conventional brachytherapy. Male incontinence is also much rarer, with fewer than one in 100 patients suffering bladder problems afterwards and, unlike surgery, patients do not need to use a catheter. The treatment is at least as successful at eradicating cancer as surgery and is slightly cheaper at around £5,000 per patient.
The technique’s pioneer, consultant urological surgeon Professor Stephen Langley, said surgery and 4D brachytherapy were ‘chalk and cheese’. He said: ‘One option takes five hours and involves a catheter, the other takes 30 minutes and you are out the same day.
‘They are for the same disease, just different treatments.’
Professor Langley is training doctors from a number of British hospitals in the hope that the treatment will soon be in widespread use.
Meg Burgess, specialist nurse at The Prostate Cancer Charity, said: ‘We look forward to seeing how this new technique compares to existing brachytherapy treatments and welcome any evidence of a benefit to men with prostate cancer.’
Read at the Daily Mail website at http://www.dailymail.co.uk/health/article-2156656/Operation-treat-prostate-cancer-half-hour-revealed–available-NHS.html#ixzz1xVlwDzcG
The Duke of Edinburgh may have been more prone to developing his bladder infection because of conditions during Sunday’s Diamond Jubilee Pageant, experts have said. Philip showed his determination to spend the day by the Queen’s side, standing next to her on the deck of the Royal Barge for much of the pageant, which resulted in the couple spending three hours in wet and cold conditions.
Harley Street doctor Malcolm Vandeburg said that stress, potentially brought on by the high-profile Jubilee celebrations could have led the infection to emerge when it did. A specialist in general medicine and male health problems, Dr Vandeburg also said the Duke may not have made enough visits to the toilet while on board the royal barge. Dr Vandeburg said if Philip contracted the infection prior to the boating extravaganza, he might have been in considerable pain as he waved to crowds.
“To think he could have had that and stood up all day makes it all the more remarkable, on the assumption it didn’t just start the moment they announced it,” he said.
“Given his health and the care he will undoubtedly get, I wouldn’t be unduly concerned.”
He added: “If a man gets a bladder infection, it’s usually that something else is going wrong as well.
“In a man of around 90, the thing that you would think of is some form of bladder outlet obstruction which would, at the top of the list, be some form of obstruction around the prostate.
“This would cause urine to remain in the bladder, causing an infection
Consultant urological surgeon Dr Frank Chinegwundoh agreed with Dr Vandeburg saying that bladder infections are caused by bugs already in the system, but the conditions on Sunday may have caused it to develop. Not drinking enough and infrequent visits to the toilet while on the Spirit of Chartwell may have also contributed to him developing the infection, Dr Frank Chinegwundoh said.
Dr Chinegwundoh, from Barts Health NHS Trust in London, said the most likely cause of the infection was something to do with Philip’s prostate gland, but conditions on Sunday would not have helped.
“I don’t think it helps, because he would not have had a lot of fluids nor would he have been peeing to wash out any bugs and all the wet and cold might have reduced his immune system so I think the combination of everything may have led to this.
“Urine infections are generally caused by bugs that are in your own body naturally, so it would not have been that he picked it up from somewhere during the pageant.
“It’s not that it would have caused it but, because of the circumstances he was in, it’s possible that he would not have been able to get rid of it. It might have predisposed him to it.”
He said bladder infections are often caused because of issues with the prostate gland, and when infections are not properly “flushed out”, creating a “stagnant pond” effect.
Dr Chinegwundoh said the best treatment is rest, fluids and antibiotics and the Duke would probably have had an ultrasound as well.
“The first thing would be to make sure he is hydrated and give him antibiotics, probably intravenously at first, and if there’s some prostate problems then that can be dealt with.”
He said bladder infections are usually easily treated, adding: “If you treat it early with the appropriate antibiotics then it should clear up within days so I wouldn’t have thought it a great cause of concern.
“If you left it long enough and didn’t treat with antibiotics then the infection could spread from the urinary system into the blood and that is potentially fatal.
“But it seems like the signs were recognised and he was treated fairly swiftly.”
New research presented at Atlanta, USA last week at the 107th Annual Scientific Meeting of the American Urological Association showed that Military service was linked with moderate to severe urinary incontinence in U.S. men, even after consideration of other known risk factors.
The reason why military exposure would be linked to urinary incontinence is not known according to Dr. Alayne Markland, from the University of Alabama at Birmingham and the Birmingham Department of Veterans Affair.
“We don’t know any specific details, such as the branch of service, deployment status, exposure during service, but we do feel as though more research is needed to link specific types of combat or branch of service to urinary symptoms,” Dr. Markland said.
In the study, the researchers reviewed survey data obtained from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Surveys (NHANES) on 5,297 men age 20 and older.
The men were stratified into three age groups: less than 55, between 55 and 69, and 70 years and older. Military exposure was assessed with the question: “Did you ever serve in the Armed Forces of the United States?”
Compared to men with no military exposure, those who had served in the military had significantly higher rates of any urinary incontinence (18.8% vs 10.4%) and moderate to severe urinary incontinence (8.4% vs 2.8%).
Men in the youngest age group were three times more likely to have moderate to severe urinary incontinence if they had served in the military, compared with their peers who had no military service.
However, there were no significant differences in the odds of urinary incontinence for the middle age group (OR 1.05) and the oldest group (OR 0.86).
“I hope this study will increase awareness that urinary incontinence and other urinary symptoms are common among men, especially relatively younger men who have served in the US armed forces. Treatments are available for urinary symptoms, and we need to do more research on the type of military exposure that may be contributing to this finding,” Dr. Markland said.