Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 9 of 10 in Diagnosis and Management of Prostate Cancer
After Prostate Surgery: Incontinence, Neobladder and Quality of Life
July 7, 2024
Two related questions during the session addressed what happens after prostate cancer surgery: managing urine leakage, and understanding reconstruction options that are sometimes confused with prostate cancer treatment itself.
Managing incontinence after surgery
Urine leakage after prostate cancer surgery is common, and the most practical, first-line remedy is pelvic floor muscle exercises (Kegel exercises) to help patients regain continence. If these don't resolve the problem, an artificial urinary sphincter surgery is available, but this is a last resort, not a first response.
Neobladder and ileal conduit are bladder cancer procedures, not prostate cancer ones
A detailed question asked about neobladders and ileal conduits in the context of prostate cancer treatment. Dr. Shrivastava clarified directly: both are reconstruction options used after bladder cancer surgery, not prostate cancer surgery. A neobladder is an artificial bladder built from a segment of the patient's own intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into an external bag. The choice between them depends on whether a patient is fit enough for the more complex neobladder reconstruction, which is typically offered only to patients with limited disease who can tolerate a longer procedure.
What quality of life really comes down to
On the emotional side of this question, his view was direct: whichever urinary diversion a patient ends up with becomes normal within months, patients adjust well in the long run, and what actually matters most is that the cancer is completely removed from the body.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
Is there a limitation on the number of times TURP can be done on the same patient?
Dr.Nitin Shrivastava
About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.
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Frequently Asked Questions
CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?▼
CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.
What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?▼
PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.
In case of BPH, what age range is surgery recommended instead of just urine diversion or catheterization?▼
It is not age but fitness for the procedure that matters. The doctor has operated on a 100-year-old patient, while some patients who are only 60 have too many other diseases and are too high-risk for surgery, and stay on a catheter instead. If a patient has a large prostate requiring long surgery and is high-risk, the choice to proceed with surgery understanding the risk ultimately becomes the patient's own.
After removal of prostate cancer, there is urine leakage. What is the remedy?▼
The most practical and best remedy is rehabilitation through Kegel exercises, pelvic floor muscle exercises. If these exercises don't help, an artificial urinary sphincter surgery is available, but that is the last resort.
What are the nutritional considerations for people with BPH and prostate cancer, and how can urologists and dieticians better collaborate across facilities?▼
The main risk factor for prostate cancer remains genetics and family history, but obesity is a genuine risk factor, alcohol's role is controversial, and there is some evidence linking red meat to prostate cancer, along with some supportive evidence for vitamin D, vitamin E, lycopene from tomatoes, and phytoestrogens like soy protein, though none of these are formal recommendations yet. A dietician should always be part of the urology team, since nutrition intersects directly with kidney stones, uric acid and hypertension, alongside a physical therapist to encourage exercise.
What is the first-line treatment for urine leakage after prostate cancer surgery?▼
Pelvic floor muscle exercises (Kegel exercises). Artificial urinary sphincter surgery is available if these don't work, but only as a last resort.
Are neobladder and ileal conduit prostate cancer treatments?▼
No, both are reconstruction options after bladder cancer surgery, not prostate cancer surgery. A neobladder rebuilds an artificial bladder from intestine so the patient passes urine naturally; an ileal conduit diverts urine to an external bag.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer