The body’s urinary function is controlled by two pairs of muscles: the bladder forceps (blue area in Figure 1) and the urethral sphincter (red area in Figure 1). The bladder muscles are located in the bladder wall and, as the name implies, are the muscles that force urine to pass, while the urethral sphincter is located at the junction of the urethra and prostate and is the muscle that restrains urine to stay. When we want to urinate, the nerves will control the sphincter to relax and rest, and make the force urinary muscle work hard, so that the urine in the bladder will gurgle out; while usually when not urinating, the sphincter is working, the force urinary muscle is at rest, so the urine will be restrained in the bladder. In addition to these two main muscles, there is also a guard around the urethra called the anal raphe (green area in Figure 1) that assists the sphincter in maintaining tone and restraining the urine discharge together. So why does urinary incontinence occur with radical prostate cancer surgery? We can see in Figure 1 that the urethral sphincter (red area) is small and thin compared to the bladder forceps (blue area) and is more vulnerable to damage. When the surgeon removes the prostate (black dashed line in Figure 1), if the urethral sphincter is damaged or the nerves that control it are damaged, it is the equivalent of giving the most important guardian of urine restraint a long vacation, so that it is always at rest, which makes it difficult to control urination. Of course, patients should not worry too much, with advances in surgical techniques, experienced surgeons can basically avoid incontinence. Studies have shown that more than 90% of patients are now able to regain urinary control within one year, with only 5% of patients suffering from complete incontinence. In my personal clinical experience, some patients may suffer from incontinence for 1 month after surgery, but with regular pelvic floor muscle training, the majority of patients are incontinent for 2 to 3 months after surgery. Those patients who still have symptoms of urinary incontinence are often the result of a lack of proper pelvic floor muscle training. After re-coaching, most of them are able to slowly regain urinary control within 3 months. So what is pelvic floor training? How can this training be done correctly? Pelvic floor training is the exercise of the muscles at the base of the pelvis, and a key part of this is the exercise of the anal raphe (the green area in Figure 1, another defender that helps the sphincter to restrain urine as mentioned earlier). Anatomically, the anal raphe is composed of the triplet brothers, the puborectalis, pubococcygeus and iliococcygeus muscles. The difficulty in training the pelvic floor muscle groups lies in finding the anal raphe correctly. In summary, there are three ways to find the anal raphe: 1, from the location, the anal raphe is located between the scrotum and the anus, that is, the middle of the perineum, when erect, this part will also have some blood, and you want to poop and can not find the toilet is also here to control; 2, interrupt urination method: when urinating two legs apart and shoulder width, and keep both legs still, concentrate on the intention to try to The most tense muscle felt when the urine flow is interrupted is the anal raphe; 3, erection control method: concentrate on contracting the perineum when erect, and feel the penis is more fully engorged with blood when the contraction is the anal raphe. After finding the anal raphe, we can start training. The first is the duration of each movement and the second is the number of times the movement is completed. When contracting the anal raphe, you need to make the muscle contract to its maximum level within 1 to 2 seconds and keep the muscle tense for more than 3 seconds, then relax for 2-3 seconds, and so on. As the training intensifies, the time to hold the contracted muscles can be increased appropriately. Every 10-15 contractions count as one group, at least 3 groups per day, that is, at least 300 times per day, with the strengthening of the exercise, the number should gradually increase until 500 or even thousands of times. In addition, in the training needs to relax the abdomen, the abdominal muscles must not be hard, but also pay attention to the amount of strength, starting from a light amount, slowly add up. If the above methods are strictly followed, most patients will not have serious incontinence within 3 months, and a few patients may need a year to fully recover. If there is no improvement for more than a year, it means that the patient’s urinary control function is not good before the surgery itself, or the cancer invades more and the surgery is more damaged, so other methods are needed to overcome incontinence. The following methods can be used: 1) installing artificial urethral sphincter to replace the function of own sphincter; 2) performing urethral suspension; 3) implanting adjustable balloon to control the bladder neck and posterior urethra; 4) stem cell implantation therapy, etc. Among them, the method of installing an artificial urethra is the most effective and is currently the preferred method of treatment for complete urinary incontinence. In conclusion, for most patients, encountering post-operative incontinence does not require panic, first of all, find a doctor to clarify whether your pelvic floor muscle exercise method is appropriate, followed by persistent exercise, if there is no improvement after a year, you can also find a physician to help you use other therapies, you can not let incontinence interfere with your state of mind and quality of life.