Drs. Zachary Klaassen and Sherita King discuss strategies for managing urinary incontinence after prostate cancer surgery, including Kegel exercises, pelvic floor physical therapy, and advanced treatment options such as male slings and artificial urinary sphincters. They emphasize that most men can significantly improve or regain urinary control with the right combination of rehabilitation and treatment.
Dr. Zachary Klaassen:
I think one of the corollaries to that is men that have incontinence or leaking after surgery can be very debilitating, can be very disconcerting to the point where they may not want to leave the house. So I know you do a lot of work with incontinence. So speak to that aspect of the survivorship as well.
Dr. Sherita King:
So as far as incontinence goes, the way that we work this is we start them off with Kegel exercises. I try to do that pre-op if I catch them.
Dr. Zachary Klaassen:
Just tell our viewers what Kegel exercises are.
Dr. Sherita King:
So Kegel exercises is an exercise ... So imagine you are trying to hold in urine, or say you're on a big date-
Dr. Zachary Klaassen:
Yes.
Dr. Sherita King:
... and you don't want to pass gas, those muscles that you're squeezing to hold that in-
Dr. Zachary Klaassen:
That's right.
Dr. Sherita King:
... those are the muscles that you squeeze for a Kegel and you'll squeeze them, hold them for a couple of counts and then relax, and then you do that multiple times throughout the day. You do different series of reps throughout the day to try to regain some of your pelvic floor musculature. Now, that's just the beginning. After surgery, I try to get them into our pelvic floor physical therapist. This is something that I learned when I was in fellowship-
Dr. Zachary Klaassen:
Sure.
Dr. Sherita King:
... to really try to incorporate. What they do is like Kegels on steroids. That's what I tell patients. So they're able to take them from just doing these simple tightening and relaxation of the pelvic floor to having biofeedback. So things that they can actually get measurements and know how well they're doing, and they have a whole host of other exercises that they can teach the patient to try to help with their incontinence. What all this is doing is trying to build up the pelvic floor musculature so they're able to control when urine is going to leak. So I'll tell patients, if you're going to go bend over and pick up something, you know that's one of your triggers to leak, do a Kegel, do those exercises at that point. Or if you're about to sneeze-
Dr. Zachary Klaassen:
Sure.
Dr. Sherita King:
... do a Kegel. Those things empower men at the beginning.
Dr. Zachary Klaassen:
Retrain the body to do that?
Dr. Sherita King:
Yeah. Exactly.
Dr. Zachary Klaassen:
So tell us a little more about some of the more advanced procedures or interventions for people that are really miserable with incontinence.
Dr. Sherita King:
Okay. So for incontinence, we have two different treatment options there for men. You have a sling and then you also have an artificial urinary sphincter. So the sling is definitely the least invasive of the two. It's just a piece of mesh that we implant into the perineum. So that's the area between the scrotum and the anus where the urethra starts to dive into the pelvis. So once we get to that area, we put a piece of mesh there, and it's going to elevate the urethra back into the pelvis.
Dr. Zachary Klaassen:
I see.
Dr. Sherita King:
Then one of them even has compression of the urethra a little bit. So what those two things do is it's increasing the resistance of the urethra. So when they do the cough or sneeze or bend over, then they don't have the leakage. With the artificial sphincter, it's a little bit more involved. With this one, we have to dissect all the way around the urethra and we place a cuff. That cuff stays closed at baseline. Okay?
So when they want to go to the bathroom, they have to squeeze a pump that's going to push the fluid that's in that cuff up to a balloon that's in their abdomen. Then the good thing about the AUS or the artificial sphincter is that you don't have to pump it to reactivate it. It's an automatic thing because that balloon is under pressure. It pushes that fluid back down within 90 seconds. So they have about 90 seconds to be able to urinate. So it just depends on how severe their leakage is.
Dr. Zachary Klaassen:
I see.
Dr. Sherita King:
So if they have mild to moderate, then we do the sling. If they have moderate to severe, then we can do the artificial sphincter.
Dr. Zachary Klaassen:
I see. So basically to summarize, I take the prostate out, these patients come see you either before or afterwards, and there'll be a period of recovery time. Everybody has to heal. So at some point as they go down their patient journey, whether it's several months, several years or even further out, you've got phenomenal options to basically get them to the point where they're dry, they're not leaking urine.
Dr. Sherita King:
Exactly. Exactly.
Dr. Zachary Klaassen:
Fantastic.
Dr. Sherita King:
Whatever they want to do, we can get them there.