Stress urinary incontinence after radical prostate cancer surgery and how to rehabilitate yourself

  Urinary incontinence is an important problem affecting patients’ quality of life after radical prostate cancer surgery, with an incidence of 45.1%-65.6%, most of which are stress urinary incontinence. Walsh reported that only 0.3% of patients with severe incontinence after radical prostatectomy required placement of an artificial sphincter.  The main factors for urinary control in men include: normal bladder compliance and stability; proximal sphincter, and distal sphincter. Since the proximal urethral sphincter is removed during radical prostate cancer surgery, the only postoperative urinary control relies on the distal sphincter; postoperative urinary incontinence is likely to occur due to factors such as local ischemia and scar adhesions of the distal sphincter that may occur intraoperatively or postoperatively.  Pelvic floor muscle exercise combined with bladder behavioral training therapy: is a simple, easy and effective basic treatment for urinary incontinence and can be the first choice for the initial treatment of mild to moderate incontinence after radical prostate cancer surgery. Kegel, an American obstetrician and gynecologist, created the pelvic floor muscle exercise method to prevent and treat urinary incontinence in 1940. Currently, the effectiveness of performing pelvic floor muscle exercises to prevent and treat urinary incontinence is widely recognized. Pelvic floor muscle exercises result in changes in the pelvic floor nerves and strengthening of muscle contraction strength and tone, providing structural support for the bladder and urethra, while strengthening the urethral sphincter.  Bladder behavioral training therapy improves bladder compliance by training patients to gradually lengthen the interval between voiding. The combination of pelvic floor muscle exercise and bladder behavioral training therapy has a synergistic effect.  Pelvic floor exercises and bladder behavioral training methods: Pelvic floor exercises: Autonomic contraction of the muscles around the pubic bone and coccyx without contracting the muscles of the lower extremities, abdomen and buttocks. Patients can choose a lying or standing position or sitting position depending on their condition. Perform tightening of the pelvic floor muscles, try to tighten and lift the muscles to maintain lOs, then relax and rest for 10 s. The above action is 1 time. 2O one 30 times for 1 group, every 3 groups, for 3 months.  Bladder training: The bladder training method can increase the bladder capacity and prolong the interval of urination. Patients are trained to gradually extend the interval between voiding to every 2-3 hours, so that the voiding situation can be continuously improved. How to do this: Stand still before each toileting session and contract the pelvic floor muscles until the urgency disappears and then relax. Gradually postpone urination for l-15 min, gradually increase bladder capacity and reduce the number of toileting sessions.  Instruct the patient to ensure fluid intake. Explain the necessity of water to stimulate the urination reflex, relieve the patient’s mind and increase the fluid intake to ensure 2000-3000ml per day. 4-6 weeks of training is a course of treatment.