posted by admin on Mar 30

Incontinence affects from 2 percent to 4 percent of men who have a TUR. It can have several causes: One is damage during surgery to the external sphincter—the valve that opens and shuts at the junction between the prostate and urethra (see figure 5.1). Another is a bladder that’s been damaged and rendered hypersensitive by months or years of urinary obstruction from BPH; it might be that surgery has come too late to undo the years of damage. A third possibility is that there’s some residual prostatic tissue blocking the urethra, which either is holding the external sphincter open or is obstructing the urethra, producing overflow incontinence.

Most men experience temporary urgency and stress incontinence after the catheter is removed; it takes the urethra hours to days to recover from being stretched or irritated by having the catheter inside. There’s also something you can do to help control stress incontinence—Kegel exercises, which strengthen the external sphincter. The best way to do them is when standing to urinate: Try to start and stop your urinary stream by contracting the muscles in your buttocks. There are other methods of performing Kegel exercises, but by doing them this way you can be sure you’re exercising the right muscles.

If incontinence doesn’t get better over time, your doctor may do cystometry to determine the state of the bladder, or check with a cystoscope to make sure there’s no residual prostatic tissue blocking the urethra. Some drugs may also help: If you have urgency incontinence, for example, anticholinergic drugs can help stop involuntary bladder contractions. For stress incontinence, drugs that cause smooth muscle tissue to contract—such as nasal decongestants, or even an antidepressant that often makes it more difficult to urinate (a drug called imiprimine)—can help. If incontinence persists for more than a year, or is severe, your doctor may suggest further treatment—possibly placement of an artificial sphincter. In this procedure, a rubbery cuff is positioned around the urethra and connected by tubing to a reservoir for fluid that’s installed in the abdomen, and to a small pump, placed in the scrotum. The pump transfers fluid from the reservoir to inflate the cuff (and block the urethra), and a valve next to the pump can be released to deflate the cuff and allow urine to pass through the urethra. The artificial sphincter is an elaborate device; but there are several simpler solutions that involve injecting material (collagen) into the tissue around the urethra or bladder neck. It’s possible that with further refinements, these techniques will be sufficient for managing incontinence in almost all men who develop it.

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