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Suggest remedies for urinary incontinence after a TURP surgery

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Posted on Thu, 19 May 2016
Question: My Dad's urethra was left without control after a botched TURP. It is open all the time and therefore he has major incontinence. He has a Supra-pubic catheter in his bladder in the hopes the regular opening would close. Three plus years later it has not closed. The Urologist is going to cauterize the urethra. What are the things to worry about? Do you think that will close the hole?
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Answered by Dr. P. T. Patil (38 minutes later)
Brief Answer:
Need detail clarification

Detailed Answer:
Hello Thanks for your query,based on the facts that you have posted it appears that your father has developed incontinence of urine after surgery of TURP which has not resolved even after three years .
I shall be happy if you can post me few more details to help me in making comments on your problem
1) What is the age of your father ?
2) Was surgery of TURP done foe Enlarged Prostate or Cancer of Prostate ?
3) Was the surgery of TURP uneventful ?
4) Was there any post operative complications like bleeding etc ?
5) Does he have opening in urethra (Other than normal urethral opening) is he leaking urine from this new opening?
6) Is it possible to upload photograph of his penis with hole ?

Normally incontinence of urine results from the injury to muscle that controls urination (Urethral Sphincter) during surgery .

Since he is on SPC since long time and there is no improvement in his symptoms it is unlikely that he will regain control naturally .

He needs surgery of putting atrificial sphinter to control urination .Your urologist will explain you about the mechaanism and surgery of putting this artificial sphincter .

Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you.
Thanks and Regards.
Dr.Patil


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. P. T. Patil (1 hour later)
good point. Let me get more details for you.

Dad had prostate cancer; it is now clear. He had radiation therapy--seeds were implanted. That was, oh...11 years ago or so. BEFORE the cancer, he had had, I think, two TURP's done because of the enlarged prostate that blocked the urethra. they were successful for a time, but scar tissue would form and block things up again.

After the radiation, the cancer was gone (hurrah!) however, the scar tissue remained. I think he did another four or five TURPs. The LAST one the doctor (no longer in the area, not our current urologist) really cleaned things out and in doing so he cut too much out and damaged the sphincter. So, where onceDad couldn't go because the urethra was closed, now it was opened and would not close up!

We did "install" an artificial sphincter that never did work well. Actually, I don't think it ever worked properly! It certainly did not close up the urethra as it should have done. Eventually, our new urologist removed it as well as removing the mesh sling that was yet another operation that attempted to support the bladder and help stop/control the urine flow to a natural process. Eventually, our current doctor removed everything as the mesh was disintegrating and digging into what was left with of the poor urethra. (Then there was the bladder stone operation. Apparently, dad grew some whopping stones! they are gone now too.)

So, the urethra was open with no control. Dad had a catheter in the penis for weeks and, of course, that got infected all the time. Also, that is irritating apparently. I don't have the same issue, so I can only imagine that problem.

ANYWAY---he had a supra-pubic put in with the hope that the regular urethra would close up with scar tissue again. That was three years ago and it has not.

The SPC works...sort of, but it just depends on where the catheter sits in the bladder as to which opening will get the urine. Sometimes it is the catheter, sometimes it is the penis. So he has all the XXXXXXX of being on a catheter 27/7 with a hole in his belly AND having to wear pads in an attempt to keep up with the urine that leaks out the old fashion way. Needless to day, accidents happen and he hates to even leave the house for long periods of time.

So, the doc suggested that he go in and cauterize the urethra to close it up once and for all. Dad knows he can't get rid of the SPC. He is stuck with that but he would be so much happier (we all would) if he only had ONE opening for urine, not two.

Let me answer your questions below.


1) What is the age of your father ? He is 89
2) Was surgery of TURP done foe Enlarged Prostate or Cancer of Prostate ? Cancer...which is now all gone.
3) Was the surgery of TURP uneventful ? They were until that last one which opened up too much. A simple operation led to a night in ICU trying to stop the bleeding. Eventually, it was stopped, obviously, but the urine flows freely.
4) Was there any post operative complications like bleeding etc ? Yes, bleeding because too much was removed during the operation and perhaps a muscle was clipped too. That was over...umm..four years ago or so.
5) Does he have opening in urethra (Other than normal urethral opening) is he leaking urine from this new opening? No. The urethral opening is the one and only one, but the sphincter has no control. Basically, it doesn't work and the mechanical one did not work either. It could not close off the urethra enough. Maybe Dad as a small urethra or something?

6) Is it possible to upload photograph of his penis with hole ? There is no abnormal hole in that area. Just a sphincter that no longer works and the artificial sphincter didn't work.

So, will cauterizing the urethral opening at the bladder work? I know no one can say 100% for sure, and if it doesn't Dad is no worse off than he is now. It is just this is the last thing to try that Dad is willing to do. (there was another operation that took the urethra's directly from the kidneys bypassing the bladder, but it was a complicated, I and think dangerous surgery for an 89 year old. And it led to many other potential problems. We nixed that idea. whew. That one really scared me and I'm glad he decided against that. I'm hoping that blocking off the urethra will force the urine to go only to catheter which would be just fine.
doctor
Answered by Dr. P. T. Patil (45 minutes later)
Brief Answer:
Thanks for detailing sequence of events .

Detailed Answer:
Hello
Thanks for feedback and detailing all the facts and surgeries he has undergone .

I would like to summarize as follow .
He had Cancer of the prostate which was successfully treated with radiation .The radiation is known to cause fibrosis and narrowing of prostatic urethra which was eventually treated with successive TURP four times .which has resulted in damage to urethral sphincter causing Incontinence of urine which did not get resolved with artificial sphincter which needed to be removed ,

In view of his age and severity of multiple problems I would suggest following mode of treatment .
1) Close the bladder neck by open surgery so that no urine will enter in urethra .
Cauterization of urethra may or may not close it completely or it may bet open fter few months which will place him again at square one .
2) Put Silicon catheter from SPC tract and change the catheter every 6 weeks .
3) Give him anti muscuranic drugs (Darifenacin ) that prevent involuntary contraction of bladder and help to prevent leakage of urine from normal urethral opening .
4) You can use diapers along with SPC drainage .

Discuss this with your Urologist .

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. P. T. Patil

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Practicing since :1971

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Suggest remedies for urinary incontinence after a TURP surgery

Brief Answer: Need detail clarification Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that your father has developed incontinence of urine after surgery of TURP which has not resolved even after three years . I shall be happy if you can post me few more details to help me in making comments on your problem 1) What is the age of your father ? 2) Was surgery of TURP done foe Enlarged Prostate or Cancer of Prostate ? 3) Was the surgery of TURP uneventful ? 4) Was there any post operative complications like bleeding etc ? 5) Does he have opening in urethra (Other than normal urethral opening) is he leaking urine from this new opening? 6) Is it possible to upload photograph of his penis with hole ? Normally incontinence of urine results from the injury to muscle that controls urination (Urethral Sphincter) during surgery . Since he is on SPC since long time and there is no improvement in his symptoms it is unlikely that he will regain control naturally . He needs surgery of putting atrificial sphinter to control urination .Your urologist will explain you about the mechaanism and surgery of putting this artificial sphincter . Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you. Thanks and Regards. Dr.Patil