Therapies for Urinary Incontinence
The incidence of incontinence after radical prostatectomy is relatively low, and if it does occur, it is usually mild in nature. However, for those men who must contend with urinary incontinence following surgery City of Hope offers the Continence Recovery Program through our Rehabilitation Services department. This program includes one-on-one sessions with a team of physical therapists for prostate cancer patients to help them retrain their pelvic muscles to stop leaky bladders using a combination of biofeedback and exercise that specifically targets the muscles of the pelvic floor which may be affected during surgery.
The return of continence may be immediate and usually occurs within the first few months post operatively but may take as long as one year. If, after one year, a patient is still not satisfactorily continent from an urinary standpoint, patients are thoroughly evaluated to determine the etiology of their incontinence. If they are determined to have stress urinary incontinence (leakage of urine with cough and sneeze), they may be a candidate for one of three therapies. These include transurethral collagen injection, a bone-anchored perineal urethral sling, or an artificial urinary sphincter.
For more extensive information about continence recovery, view our prostatectomy Frequently Asked Questions section or learn more about Urinary Reconstruction and Diversion.
Therapies for Erectile Dysfunction
After nerve-sparing robotic laparoscopic prostatectomy, the return of erectile function may take anywhere from one day to two years. It is thought that although the neurovascular bundles are spared, the cavernosal nerves can sustain a thermal or stretch effect, leading to a temporary loss of nerve function. During this time, oral medications for erectile dysfunction may be unsuccessful because they require intact nerve function. Therefore, there are a number of second-line therapies we offer at City of Hope that act independent of nerve function, that can serve as a temporary or sometimes permanent measure to attain satisfactory erections. These treatments include intraurethral medications, penile injection therapy, or a vacuum erection device.
If these treatments prove unsuccessful, we offer patients a penile prosthesis. While this does require a surgical procedure, a penile prosthesis can be an attractive option for treatment. It is associated with over a 90 percent patient and patient/partner satisfaction rate.
A clinical study being conducted by City of Hope researcher Laura Crocitto, M.D. that evaluates whether patients who use regular, low doses of erectile function drugs soon after surgery return to potency faster than those who do not take the doses regularly. It may be important to start rehabilitation as early as possible to increase blood and oxygen flow to the penis, helping to prevent scarring and this study will start to answer that question. City of Hope researchers are looking to accrue 220 men for the study. All study related medications will be provided to men free of charge.
We provide an extensive program including a Prostate Cancer Support Group and psychosocial counseling. A clinical psychologist, Martin A. Perez, Ph.D. , with expertise in sexual dysfunction, is available to see patients. Dr. Perez’s clinical practice and research focuses on quality of life issues in cancer patients and their families, assessment and treatment of sexual dysfunction following cancer treatment.