Incontinence following Treatment for Prostate Cancer
A range of treatments are available for diagnosed prostate cancer and all are likely to have side effects, the main ones being incontinence and impotence. Although the medical profession generally will advise that there is a risk of both following treatment, precise statistics are not provided. The experience of members of the LHPCSG suggest that the actual risk is high, possibly more than 50%. The first medically recommended step is to start pelvic floor exercises to rebuild the urinary sphincter muscle but if this is unsuccessful then dealing with incontinence becomes a major problem, with little NHS information available on what options exist. This note attempts to summarise the options available at present. For more detailed information including a number of user tips for each product, go to www.continenceproductadvisor.org/products
1. Artificial Urinary Sphincter (AUS)
This patient controlled device involves a further operation and consists of a pump, a pressure regulating balloon and a cuff that encircles the urethra. It is claimed to cure or greatly improve 70 to 80% of patients but there are also reports that a further operation is needed for a replacement after a few years.
2. Incontinence Pads
These appear to be the main solution offered by the NHS with several manufacturers (www.tena.co.uk/men) (www.incontinencechoice.co.uk) providing a range of sizes to handle different urine leakages. At present the cost of these pads may not be covered by the NHS although this appears to be applied inconsistently (Post Code lottery?) The main problem with these pads is the difficulty in changing them when suitable toilets are not available.
3. Penile compression devices (clamps)
This involves fitting a simple clamp on the penis which effectively stops the urine flow but does not stop the flow of blood in the veins of the penis. They are not currently recommended by NICE in the UK but many men find them useful. Of the clamps available, the JMS J clamp (www.stressnomore.co.uk), Cunningham clamp (www.bardmedical.co.uk) and the Dribblestop (go to www.amazon.co.uk and search for "Dribblestop") are rated good in customer reviews. A trial of pads, sheaths and clamps in 2015 concluded that they have different strengths which make them suited to certain circumstances and activities. However, most men in the trial described clamps as uncomfortable or painful (careful fitting should avoid these problems) despite being the most secure, least likely to leak and the most discreet. A combination of pads and devices were preferred by 65% of the men after the test was completed.
A sheath is very similar to a contraceptive condom and can be connected to a urine drainage bag. The most popular have adhesive on the inside to allow adhesion. Alternative designs include non-adhesive sheaths held in place with an external Velcro band. Sheaths are useful for longer periods of time without access to toilets but have a tendency to fall off if left on too long. They are used with leg or waist urine drain bags which can be emptied when convenient. Suppliers include Coloplast (www.coloplast.co.uk) and BioDerm Inc. (www.clinimed.co.uk)