What to do if you have urinary incontinence after prostate surgery

The incidence of prostate cancer has been relatively high in recent years. Elderly men are a common group suffering from prostate cancer. After suffering from this disease, the most common treatment method is surgery. Urinary incontinence is prone to occur after surgery, which is also a complication of surgery. If this happens, medication must be used in time. In addition, patients must choose a larger hospital during surgery to minimize the complications of the surgery.

For patients with severe postoperative urinary incontinence, some drugs can be used as adjuvants for treatment, such as duloxetine, midodrine hydrochloride, and Chinese medicine.

An inhibitor of norepinephrine reabsorption, it can promote the activity of the urethral striated sphincter and enhance the excitability of the pudendal nerve by stimulating Onuf's nucleus. Midodrine hydrochloride is a prodrug that is enzymatically hydrolyzed and metabolized into the pharmacologically active substance deglymidodrine, which selectively stimulates peripheral a-

Adrenergic receptors can achieve urine control by promoting the activity of the urethral transverse sphincter. Some patients use traditional Chinese medicine for treatment, but there is no reliable evidence to prove its effectiveness. Currently, drug treatment has some adverse reactions, and there are relatively few studies. Caution is required before clinical application.

RP intraoperative surgical techniques

Since RP

Postoperative urinary incontinence is related to the weakening of the internal urethral sphincter function. Therefore, preserving the nerves related to the internal urethral sphincter as much as possible after surgery can effectively prevent the occurrence of postoperative urinary incontinence, and urinary incontinence will recover faster. The following are some tips during the operation.

1 Preserve the vascular nerve bundle

The external urethral sphincter group is innervated by the autonomic nerves from the pelvic nerve and the somatic nerves from the pudendal nerve. The former innervates the urethral mucosa and smooth muscle, while the latter innervates the striated muscle part of the external urethral sphincter. The pelvic nerve originates from the pelvic plexus, runs below the levator ani fascia, the posterior and lateral side of the rectum, and sends out many branches to innervate the rectum. At the level of the prostate tip, it sends out many branches to enter the 5 o'clock and 7 o'clock positions of the urethral striated sphincter; the main trunk of the pudendal nerve sends out pelvic branches from the pudendal canal, passes through the levator ani muscle and enters the pelvic cavity, accompanies the pelvic nerve for a while, then joins the pelvic nerve and reaches the urethral striated sphincter together. Xu Yong et al., Yu Jianjun et al. have conducted research on the prevention of urinary incontinence after RP by preserving the puboprostatic ligament and deep dorsal penile veins during surgery. Good surgical results were achieved after the operation. Currently, this surgical method has been widely used in clinical practice.

3. Preserve a sufficiently long membranous urethra. Zhang Fan et al. have studied the correlation between the recovery of urinary control function after laparoscopic radical prostatectomy and the membranous urethral length (MUL) measured by preoperative magnetic resonance imaging (MRI). Studies have shown that patients with MUL < 14 mm who undergo laparoscopic radical prostatectomy have delayed recovery of urinary control function and a significantly increased incidence of urinary incontinence in the early postoperative period (3 months). Preserving a sufficiently long membranous urethra as much as possible can increase urethral stasis pressure and ensure that the intraurethral pressure is higher than the intrabladder pressure, thereby achieving urinary control function.

There has been controversy over the role of preserving the bladder neck in reducing urinary incontinence, because freezing or pathological examination of the preserved bladder neck may reveal residual prostate tissue, which may pose a risk of tumor recurrence. However, studies have shown that the bladder neck has a role in controlling urine, so the bladder neck can be reconstructed without preserving the bladder neck. The specific surgical operation is: after the prostate is removed, the bladder neck opening is reshaped to a diameter of 1.5 cm, and the bladder mucosa is fully everted and then sutured with 4 stitches at intervals to fix it. On the posterior wall of the bladder, 2.0 cm away from the reshaped bladder neck opening, 1 stitch is folded and sutured with silk thread. The residual urethra and everted bladder neck are sutured intermittently and without tension at 2, 4, 6, 8, and 10 o'clock, which has a certain effect on increasing the tension of the bladder neck and reducing urinary incontinence.