Bladder problems after treatment for prostate cancer:
You may experience bladder issues following prostate cancer surgery or radiotherapy. These problems can include:
The testicles
The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.
Image of the testicles (cruk)
Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.
The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.
Testosterone:
The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:- A deeper voice
- Facial hair growth
- Increased muscle mass
- The ability to achieve an erection
- Male sexual drive (libido)
Where does testicular cancer start:
The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:- Seminoma
- Non-seminoma
You may experience bladder issues following prostate cancer surgery or radiotherapy. These problems can include:
– Urine leakage
– Bladder inflammation
– Trouble passing urine
Leaking Urine:
Urine leakage is a common issue after prostate cancer treatment. Coping with this side effect can be challenging, but there are strategies and support available to help you and your family manage it.
Leaking urine after surgery to remove the prostate gland:
After surgery to remove the prostate gland (called radical prostatectomy), about 70 out of 100 men (70%) have trouble controlling their bladder six months later.
When you wake up from the operation, you’ll have a tube in your bladder to drain urine. This tube, called a urinary catheter, stays in for a couple of weeks. Later, you’ll go back to the hospital to have it removed.
When the catheter is taken out, you might experience some urine leakage. It’s helpful to have incontinence pads ready at home and bring some to the hospital. You can buy these at supermarkets or pharmacies.
Leaking urine can affect your activities and where you go in the weeks following surgery. This varies from person to person. Some men have no problems, while others might dribble urine or leak more when they cough, sneeze (called stress incontinence), or have an erection or orgasm.
It’s hard to predict how long it will take to regain bladder control. This varies depending on the type of surgery and any issues during or before the operation. Most people improve within 3 to 6 months, but for some, it could take 1 to 2 years. A few men might have ongoing urinary issues.
Leaking urine after radiotherapy:
Around 40 out of 100 men (40%) have difficulty controlling their bladder six months after receiving radiotherapy.
Following radiotherapy, you might gradually experience increased difficulty passing urine over several weeks or months. This can happen because the treatment can narrow the tube that connects the bladder to the penis, known as the urethra. If this occurs, a minor procedure to widen the urethra may be an option.
Some men may experience complete loss of bladder control, though this is rare. If this happens, options include using a urinary sheath or pad, or having a urinary catheter to drain urine into a bag.
Who can help you:
Your doctor or specialist nurse can recommend a continence clinic if bladder control becomes an issue. These clinics specialize in helping manage such concerns through muscle exercises and bladder training.
Pelvic floor exercises:
Pelvic floor exercises are specifically designed to strengthen the muscles that control bladder function. Your doctor or specialist nurse will guide you through these exercises, which have been shown to effectively reduce or stop urine leakage.
If you haven’t received instructions on pelvic floor exercises, don’t hesitate to ask your specialist nurse. Alternatively, you can request a session with a physiotherapist who can provide detailed guidance on performing these exercises.
Absorbent pads and bedding for managing incontinence:
When you start going out, you may need to use pads. There are various types available, and you might be eligible for free pads through the NHS, depending on your local service. Some GP practices have continence nurses who can assist you.
It’s helpful to visit places with accessible toilets or call ahead to check. Consider getting incontinence sheets for your bed for added peace of mind, although this may not always be necessary. Another option is a urinary sheath, resembling a condom with an opening at the tip. It fits over the penis and connects to a bag via a tube, allowing any leaked urine to drain away. This can be especially useful at night for better sleep.
Bladder Training:
Bladder training helps increase your bladder’s capacity to hold urine for longer periods. It involves keeping track of your bathroom visits in a diary and gradually extending the time between each visit.
Artificial urinary sphincter:
If you experience significant urine leakage that isn’t improved by pelvic floor exercises or bladder training, your doctor might recommend surgery to implant an artificial urinary sphincter (AUS).
During this procedure, a flexible ring is placed around the urethra. This ring connects to a small pump in the scrotum, allowing you to deflate the ring when you need to urinate.
While this device can potentially reduce or eliminate urine leakage, the surgery itself can be complex. It’s important to discuss the procedure thoroughly with your urologist to understand its benefits and risks.
Image (cruk)
Bladder Inflammation:
Radiotherapy can cause inflammation in your bladder and urethra, a condition known as radiation cystitis. Symptoms may include:
– Increased frequency of urination
– Burning or sore sensation when urinating
– Urgency to urinate
The severity of these side effects depends on the type of radiotherapy received and any pre-existing urinary issues.
If you experience these symptoms, especially if your urine appears cloudy or has a strong odor, it’s important to inform your doctor. These could indicate a possible infection.
Typically, radiation cystitis worsens during radiotherapy and for a few weeks afterward. Improvement usually begins within a few weeks to months after completing treatment. However, some men may experience delayed urinary problems months or even years later. The risk of these side effects is higher if internal radiotherapy is also used alongside external radiotherapy.
Who can help you:
If you’re experiencing bladder issues, discuss them with your doctor. They can connect you with a continence clinic where you can receive assistance such as muscle exercises, bladder training, and medications. Depending on your specific needs, there may be other treatments available to help manage your symptoms.
Drink plenty of fluids:
Make sure to drink between 6 to 8 glasses of fluids every day. It’s important not to restrict your fluid intake. Throughout the day, it’s fine to drink plenty, but consider limiting fluids two hours before bedtime.
There’s mixed feedback on whether cranberry juice helps alleviate symptoms—some find it beneficial, while others believe it worsens soreness. Research hasn’t conclusively shown its effectiveness. If you’re on warfarin, avoid cranberry juice.
Certain beverages like tea and coffee might exacerbate soreness for some individuals. It can be helpful to try different drinks to see what works best for you. Avoid using potassium citrate, sometimes referred to as “mist pot cit,” as it’s an outdated remedy for cystitis and can be harmful in large doses.
Medicines:
Your doctor may recommend medications that could alleviate your symptoms. For instance, they might prescribe drugs known as anticholinergics or alpha blockers. These medications work by relaxing the bladder muscle, allowing the bladder to hold more urine before the urge to urinate, and making it easier to pass urine.
Implanted sacral nerve stimulation:
Your doctor places small wires (electrodes) on your lower back, which deliver mild electrical pulses to the nerves responsible for controlling urination. If this proves effective for you, a permanent nerve stimulator is surgically implanted in your buttock area.
Difficulty passing urine:
After radiotherapy or surgery for prostate cancer, you may experience difficulties passing urine due to a narrowing of the urethra, known as urethral stricture. This can make urination challenging or even lead to acute urinary retention, where you’re unable to pass urine at all.
Acute urinary retention requires immediate medical attention at the hospital.
To address a narrowed urethra, doctors may perform a brief surgical procedure. This can involve inserting a thin rod into the urethra to widen it, or using a flexible tube equipped with a light and camera to visualize the narrowed area. In some cases, they may use a small knife through the tube to remove tissue and open up the urethra. These procedures are typically done under local or general anesthesia.
Depending on your condition, you may need to undergo this operation again if the urethra becomes narrowed once more.
Daignosis
If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,
Treatment options
A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected