Leaking after Prostate Cancer Surgery

Prostate cancer is a common concern among men, and while advancements in medical technology have improved treatment outcomes, they can sometimes bring along unwanted side effects. One such side effect is leaking after treatment or post-prostatectomy incontinence, which can significantly impact a man's quality of life. This post explains what post-prostatectomy incontinence is, why it happens, and the treatment options available.

Post-prostatectomy incontinence refers to the unintentional leakage of urine following a prostatectomy, a surgical procedure to remove the prostate gland. This leakage occurs because the surgery can weaken or damage the muscles and nerves that control bladder function, leading to difficulties in controlling the flow of urine. Having radiotherapy or brachytherapy can also impact the bladder which can compound the leakage.

The most common type of post-prostatectomy incontinence is leakage when you strain or move – stress incontinence. However, there can be overlap with urge incontinence, the leakage seen in overactive bladder, where you get the sudden urge to urinate and are unable to make it to the toilet in time. Post-prostatectomy incontinence is a spectrum and the symptoms you have will dictate which treatments work best.

Treatment Options

Behavioural Strategies: Lifestyle changes, such as monitoring fluid intake, managing weight, and avoiding bladder irritants like caffeine and alcohol, can help minimise incontinence episodes.

Pelvic Floor Exercises: These exercises involve strengthening the pelvic floor muscles that support bladder and bowel control. A specialist continence physiotherapist can guide patients through the proper techniques to enhance muscle tone and control.

Biofeedback: This technique uses sensors to monitor pelvic floor muscle contractions, providing real-time feedback to help patients learn how to control these muscles effectively.

Medications: Certain medications can help manage incontinence by reducing bladder spasms or increasing bladder capacity. Consulting a healthcare professional is essential to determine the appropriate medication and dosage.

Surgical Interventions: In cases of severe stress incontinence, surgical procedures such as sling surgery or artificial urinary sphincter implantation may be considered. These procedures aim to provide additional support to the urinary system. Bladder Botox injections can also be helpful where urgency is part of the picture.

Catheters and Absorbent Products: For temporary management, catheters and absorbent products can provide relief while working on improving bladder control through other methods.

Possible Side Effects

Pelvic floor work, biofeedback and lifestyle changes carry no risk, and supervised pelvic floor exercises improve stress leakage in about 70% of men (BAUS male sling leaflet, 2025). Medication for urgency can cause a dry mouth or constipation and is reviewed if it does. Bladder Botox can leave the bladder emptying incompletely for a time, so the ability to self-catheterise is discussed first; in men the chance is higher when the bladder already empties poorly (Ribeiro et al., 2023). Urethral bulking is an option for milder leakage, and its effect can wear off (Nguyen et al., 2019).

The two operations for heavier leakage, the male sling and the artificial urinary sphincter, were compared in a UK trial of 380 men (MASTER; Abrams et al., 2021). Symptoms and quality of life improved with both, symptom scores roughly halved, and most men were satisfied, although by a strict definition most still had some leakage at one year. The sling was no worse than the sphincter on the main continence measure; most other results favoured the sphincter, and by two years more men had needed further surgery after a sling (11%) than after a sphincter (2%) (Constable et al., 2026). BAUS puts satisfaction after a male sling at about seven men in ten, counting those who still use up to one pad a day. The sling after-effects BAUS lists are: no significant improvement in leakage, and stinging or bruising in the first weeks (each between 1 in 2 and 1 in 10); temporary difficulty passing urine, wound infection and new urgency (each between 1 in 10 and 1 in 50); and, between 1 in 50 and 1 in 250, groin pain that can last months or be permanent, and slow movement of the sling into the urethra years later. A mesh sling is difficult, and sometimes impossible, to remove. Persistent pain after a mesh sling was the subject of a study Mr Seth co-authored (MacAskill et al., 2021). A sphincter is a mechanical device you squeeze to open, and it can need revision over the years. Your own result depends on how much leakage you have, how long it has been since surgery, and whether you have had radiotherapy, which lowers sling success and raises its complication rate (BAUS), which is why the assessment comes first.

When to ask for review

Continence is usually a recognised part of post-prostatectomy follow-up, so the first person to mention ongoing leakage to is the urology team who carried out your operation. They will want to know whether symptoms are improving or not. If more than a year has passed since surgery and leakage is still affecting day-to-day life, it is reasonable to ask about referral for specialist continence assessment. That route is available on the NHS through your original team and privately through a urology outpatient appointment.