Incontinence after prostate surgery no big deal: men
NEW YORK (Reuters Health) - Many men have some degree of incontinence after prostate surgery, but few are significantly bothered by it, according to a poll at one U.S. hospital.
Of 315 patients who'd had their prostate removed due to cancer, only a quarter said a year or more after surgery that they never experienced any leakage.
Still, more than three-quarters of the men said they didn't use pads in their underwear and only about one in 20 said they were significantly bothered by incontinence.
"The bottom line is that many men, after having their prostate removed, will have some impact on the way they urinate," said Dr. Erik Castle, an associate professor of urology at the Mayo Clinic in Phoenix, who led the new work. "But the degree of the impact is minimal."
According to the American Cancer Society, one in six men gets prostate cancer at some point in his life and one in 36 men in the U.S. will die from it.
While there is controversy over how to treat low-risk tumors, some of which may never cause any harm if left untreated, surgery and radiation are common options when the disease is more advanced.
But men considering these treatments also face possible side effects like becoming incontinent or impotent. And getting useful information about how common these problems are is difficult, Castle said, because there are so many different ways of defining them.
"There is a lot of miscommunication," he told Reuters Health. "The goal of the study was to come up with a more detailed analysis of what men should expect after their prostate is removed."
The researchers sent out questionnaires to 600 men, from 42 to 82 years old, who'd had robot-assisted prostate surgery at their hospital.
The surveys focused on incontinence, asking a wealth of questions, including how the patient's sex life, physical activity and social life were affected.
Just over two-thirds of the men responded. At least one year after their surgery, 78 percent said they didn't use pads in their underwear, while only 26 percent said they never leaked.
"The outcomes are actually pretty darn good," said Castle, adding that some of the older men might already have been leaking before they underwent surgery.
Men who used more than one pad a day -- 17 percent -- most often leaked during exercise or when coughing and sneezing, and said their incontinence was most bothersome in relation to their sex life.
Overall, five percent of men said they were significantly bothered by their incontinence, and less than one percent reported leaking all the time.
"We just wanted to get the message across that, 'Look, the vast majority of patients had some kinds of changes in their lifestyle but are still very happy,'" Castle said, adding that less than one percent of patients have any major complications at Mayo Clinic.
Prostate removal is usually only recommended for men who are expected to live at least 10 to 15 more years. And even then, the decision should be based on individual preferences, Castle said.
For instance, if a man already has some incontinence and impotence, Castle would encourage surgery. But if he is very worried about impotence, radiation treatment might be a better way to go, because its effect on continence and potency are delayed a few years, he added.
"This study armed us with the information to be able to explain to patients what to expect when we are counseling them," Castle told Reuters Health. "We end up getting patients who say, 'Doctor, I'm very happy.'"
SOURCE: bit.ly/koe8mc The Journal of Urology, online May 14, 2011.
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