Urinary Incontinence

There are several types: stress incontinence (leakage when coughing, sneezing, exercising or lifting — most commonly seen after prostate surgery), urge incontinence (a sudden compelling need to urinate, often part of overactive bladder), mixed incontinence (a combination of stress and urge), overflow incontinence (dribbling from an over-full bladder that cannot empty properly, often from BPH), and neuropathic incontinence (also called neurogenic bladder — leakage due to nerve conditions such as spinal cord injury, multiple sclerosis or diabetes).

For most men, no. The majority of men who have a radical prostatectomy regain continence within 12 months, particularly with early pelvic floor rehabilitation. Where leakage persists beyond 12 months, effective surgical options are available — the male sling for mild-to-moderate leakage, and the artificial urinary sphincter (AUS) for moderate-to-severe leakage, with long-term success rates over 80%.

Assessment begins with a full history — including surgical history, medications and a bladder diary — and a physical examination. Investigations may include urinalysis, uroflowmetry, a bladder scan to measure post-void residual, and urodynamic studies to characterise the underlying mechanism. In selected cases, cystoscopy or MRI may be arranged. Accurate diagnosis is essential because treatment differs significantly by type.

Yes. Supervised pelvic floor (Kegel) exercises are the first-line treatment for stress incontinence, particularly after prostatectomy. Physiotherapy-led programmes achieve the best results, and starting exercises as early as possible after surgery — ideally before — speeds up the return of continence. Many men achieve significant improvement with pelvic floor training alone.

The AUS is the gold standard surgical treatment for moderate to severe stress urinary incontinence following radical prostatectomy. It is an implantable device consisting of a cuff placed around the urethra, a pressure-regulating balloon, and a control pump placed in the scrotum. It restores continence by mimicking the natural sphincter, and the patient controls it by pressing the pump to open the cuff when they wish to urinate. Long-term success rates exceed 80%.

A male sling is a synthetic mesh tape placed beneath the urethra to provide support and reduce leakage. It is suitable for men with mild-to-moderate stress incontinence, requires no mechanical device, and has a quicker recovery than the AUS. The artificial urinary sphincter, by contrast, is a fully mechanical device suited to moderate-to-severe leakage with higher long-term success rates but a longer recovery. Choice depends on the severity of leakage, prior treatments and individual anatomy.

Yes — for refractory urge incontinence (part of overactive bladder), intravesical botulinum toxin (Botox) injections into the bladder wall and sacral neuromodulation (a small implanted device that modulates the sacral nerves) are both effective options when medication and behavioural measures have not worked. Both are available at LUS and can be considered as an alternative to long-term medication.

Any man experiencing persistent leakage after prostate surgery, sudden onset of urinary symptoms, blood in the urine with incontinence, or incontinence that is significantly affecting daily life or confidence should seek specialist review. Male incontinence is a treatable medical condition, not something to be embarrassed about or accepted as inevitable — and early assessment leads to better outcomes.