Therapy May Ease Bladder Problems After Prostate Surgery

January 11, 2011


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By Anne Harding

TUESDAY, January 11 ( — Prostate-removal surgery can provide peace of mind to men who have been diagnosed with prostate cancer, but the procedure often carries an unwelcome and hard-to-treat side effect: leaky plumbing.

Up to 65% of men who have had their prostates removed—a procedure known as radical prostatectomy—experience some form of urinary incontinence for years afterward, whether it’s stress incontinence (leakage when they sneeze, lift something heavy, or otherwise stress their pelvic muscles), urge incontinence (a sudden and uncontrollable need to urinate), or some combination of the two.

A new study in the Journal of the American Medical Association suggests that special training in bladder-control strategies, such as learning to contract and relax the muscles that control urine flow, can help reduce incontinence—even in men who are a decade or more removed from surgery.

In the study, men who had been having an average of four incontinence episodes per day experienced fewer than two episodes per day after completing eight weeks of the training, known as behavioral therapy. And the effects of the therapy seemed to be lasting; after one year, the incontinence among the men had not measurably worsened.

“They were very grateful for the treatment,” says the lead researcher, Patricia Goode, MD, medical director of the continence clinic at the University of Alabama at Birmingham Center for Aging. “It was sort of empowering for them. … They were very glad to find a therapy that they could do themselves.”

The treatment was far from a cure, however. Only about 1 in 6 men who received behavioral therapy saw their bladder problems disappear altogether, although this was a much better rate than in the control group, in which just 1 in 16 men stopped being incontinent.

The persistent incontinence among the men who completed therapy suggests that the treatment may not justify the cost and time investment, says David F. Penson, MD, a professor of urologic surgery at Vanderbilt University, in Nashville.

“The question you have to ask yourself right off the bat is, is the bang worth the buck?” says Dr. Penson, who wrote an editorial accompanying the study. Even if it’s covered by insurance, behavioral therapy requires a considerable time commitment, and may require patients to take time away from work, Dr. Penson notes.

Dr. Goode acknowledges that most of the men in the study continued to experience “a significant amount of leakage” post-therapy, but she stresses that the participants reported that the therapy still made a difference in their quality of life.

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