How to Help Children with Urinary Incontinence at School

Children washing their hands at a bathroom school, working against urinary incontinence at school.

By Dr. Wolfgang Cerwinka, M.D.

More than 90% of children will be toilet trained at the age of 5 years. At that age, the most common type of incontinence is bed wetting or enuresis. Urinary incontinence is the involuntary loss of urine and may be caused by a variety of reasons. Bed wetting may be the sole problem or may occur together with daytime urinary incontinence.

If bed wetting is associated with daytime urinary incontinence at school, it may be regarded as the nightly expression of the same problem that occurs during waking hours. Therefore, that issue will respond well to the treatment of daytime urinary incontinence.

Learn more about daytime urinary incontinence at school below!

What Causes Urinary Incontinence at School?

Gaining control over bladder and bowel is a process that depends on normal anatomy (e.g., normal bladder size), function (e.g., the normal ability of the bladder to relax when storing urine) and learned behavior (e.g., ability to sense a full bladder). Bladder and bowel problems occur often together and are summarized under the term bladder-bowel dysfunction (BBD).

The reason for this association is that bladder and rectum share the same embryological origin, the same nervous control, and are located in close proximity. It is easy to imagine how a full rectum with constipation that is located behind the bladder will reduce the space for the bladder to hold urine. Therefore, bladder and bowel problems should be managed in concert. Since behavior and learning are an important part of gaining bladder and bowel control, patients with behavioral (e.g, ADHD) and learning disabilities are often diagnosed with BBD. Training the bladder and bowel is a process that will take time and requires patience.

Children with urinary continence at school typically suffer from urgency incontinence (inability to postpone voiding). These children are initially managed by prolonged toilet training and eventually will see their pediatrician who, if comfortable with this problem, will implement basic treatment. If urinary incontinence persists and is deemed socially unacceptable, patients are referred to a pediatric urologist.

At Georgia Pediatric Urology, patients are seen in the HAWK (“Help Awaiting Wet Kids”) Clinic, which was specifically established for the treatment of BBD. Extended clinic visits allow finding the correct diagnosis and time to discuss treatment options in detail. At the initial clinic visit, besides obtaining the medical history and performing a physical exam, basic tests will be done such as a urinalysis (urinary tract infection may cause incontinence), a renal-bladder ultrasound (verify a normal anatomy), a postvoid residual ultrasound (verify complete bladder emptying) and a uroflow test (verify normal urine flow from the bladder).

How Do You Treat Daytime Urinary Incontinence at School?

Management of urinary incontinence is initially empiric and a step-wise process. This means that treatment is based on what in our experience works best, and, if urinary incontinence persists, to include other treatment options. Basic management encompasses behavioral and dietary modifications and to work with the school to allow children to visit the bathroom as necessary. Further, balancing fluid intake, reducing foods that will cause bladder over-activity (e.g., caffeine), treating constipation, and proper voiding (in a timely fashion and complete) also help.

If urinary incontinence persists, either biofeedback training (if patients have a hard time emptying their bladders completely) or the addition of bladder-relaxing medications are options. If treatment is still not successful, a video-urodynamic study will be scheduled in the office which is a test where a bladder catheter has to be placed to specifically study bladder function and to determine the exact cause of incontinence.

Typically, one or a combination of treatment modalities paired with continued toilet training and time to allow the urinary system to mature will successfully manage urinary incontinence in affected children.

If you have any more questions or concerns about urinary incontinence at school, click here to contact the pediatric urologists at Georgia Urology.

Staff Spotlight: Jacquar Wynn

Georgia Urology is full of incredible, hard-working, and dedicated employees. We’re excited to highlight these wonderful medical professionals who serve our patients every day through monthly Staff Spotlights!

Two photos of Jacquar. The one on the left is her smiling at the Georgia Urology office, and the one on the right is her with her son.

This month, we’re highlighting Georgia Urology’s Front Desk Coordinator, Jacquar Wynn, who has been with us for nine months.

1. What’s the most rewarding part of your job?

The most rewarding part of my job is delivering the best customer service experience by caring for and reassuring patients that they are in good care. Ultimately, providing a wholesome, stress-free and welcoming environment. Knowing that I can put a smile on a patient’s face is magnificent!

2. Do you have any advice for people hoping to work in your field?

My advice for anyone considering entering the medical field is to be compassionate! Patients depend on our compassion and commitment to their overall well-being.

3. What are your favorite hobbies?

My favorite pastime is having family gatherings at my house. I love to pull my family and friends together and fellowship. I also love interior decorating. In my spare time, I often like to re-arrange my home décor or my friend’s and family’s homes.

My son, Taurean, attends The University of Texas. He gives me a sprinkle of his time here and there. When we get together, we’ll attend Cedar Point Amusement Park and have a ball.

GU Pediatric Urology Care Recognized Among Top 10 in U.S. News & World Report Rankings

Congratulations to our pediatric urologists honored among the professionals honored in U.S. News & World Report’s 2019-2020 Best Children’s Hospitals rankings. This annual recognition signifies excellence among the country’s pediatric healthcare landscape.

Our wholly-owned subsidiary, Georgia Pediatric Urology, collaborates with and provides pediatric urological services at Children’s Healthcare of Atlanta, which occupies a top-10 spot in the magazine’s Best Hospitals for Pediatric Urology category.

“The U.S. News & World Report designation is important because it tells the public we are a pediatric urology center dedicated to quality outcomes,” says Dr. Hal Scherz, a pediatric urologist and managing partner of Georgia Urology. “It gives the public a sense of reassurance that the care their children will receive from Georgia Urology is going to be as good as it can be anywhere in the country.”

Of our 45 specialty-trained physicians, the seven making up Georgia Pediatric Urology are fellowship-trained pediatric urologists with expertise in the diagnosis and treatment of urological problems affecting boys and girls, from newborns to late teens. These conditions include congenital abnormalities, genitalia, pediatric urologic cancers, kidney and bladder issues, and more. Our HAWK (Help Awaiting Wet Kids) Center provides specialized care for children with wetting issues and other forms of abnormal urination.

Georgia Pediatric Urology differs in that we are a private practice, pediatric urology group. This allows us to serve through various avenues. In addition to our involvement in the children’s hospital world, we train Emory University residents and offer one of the longest-running pediatric urology fellowships in the country.

“We’ve worked very hard to put together the pieces necessary to establish a top-tier pediatric urology group,” Dr. Scherz explains. “The U.S. News & World Report designation validates all of the hard work and dedication everyone in our group has contributed. And we’re not done yet. We’re always growing, improving, expanding, and making the programs better for children who have pediatric urological problems.”

You can make an appointment with Georgia Urology and Georgia Pediatric Urology can by calling 678-284-4053 or contacting us here.

Infertility in Males — It’s Not Just the Woman

Male and female couple at a doctor's desk, holding hands and discussing Infertility in Males.

By Dr. Lawrence Goldstone, M.D., F.A.C.S.

Infertility is defined as a couples inability to conceive after one year of appropriately timed and unprotected intercourse. It can affect 15% of couples. Typically thought to be a woman’s problem, infertility in males is actually the primary factor in 20-30% of cases, and is a contributor as a combined couples problem an additional 20-30% of the time.

The evaluation of infertility in males is a relatively simple and straightforward process. It begins with a thorough history, focusing on sexual history, the timing of intercourse, and the use of lubricants. A past history of prior surgeries in the pelvis or reproductive tract will be noted, as well as a history of pain, swelling, or infections in that area.

Medicines and lifestyle choices will be carefully reviewed. Smoking (both tobacco and marijuana) and alcohol can affect sperm health. Testosterone supplements and anabolic steroid usage are an increasingly common cause of male factor infertility. Stress, obesity, and even prolonged heat exposure to the genital area may adversely affect sperm quality.

A physical exam with attention to testicular size and quality will be performed. The presence or absence of the vas deferens(the tube that carries sperm from the testicle) can easily be addressed. Your physician will also check for vein swellings in the scrotum called varicoceles that can impact sperm counts and function.

A semen analysis will be arranged if not already performed. This gives valuable information about semen volume, sperm quantity, and quality. Laboratory testing can provide important clues to hormonal imbalances and chromosomal abnormalities that may affect reproductive health. Ultrasound examinations of the genital tract may occasionally be arranged. In summary, the evaluation is relatively quick and simple and can often be accomplished after only one or two office visits.

Treatment of infertility in males will, of course, depend on the underlying factors. It may be as simple as lifestyle modifications and timing and frequency of intercourse. Medications may be used, particularly for hormonal imbalances. Minor surgeries to correct varicoceles can often be helpful. There are even procedures to retrieve sperm from men who were previously thought to be completely sterile and without hope.

In summary, male factor infertility is a common problem and the physicians at Georgia Urology are well-focused on its improvement. Click here to schedule an appointment with us today if you want to discuss further. 

Common Pediatric Urology Sports Injuries

Low Angle View Of Male High School Soccer Players And Coach Having Team Talk about common pediatric urology sports injuries.

By Dr. Edwin A. Smith, M.D., F.A.A.P., F.A.C.S.

Sports are a great way for kids to work on their physical health while also learning important lessons about community, commitment, and responsibility. However, sometimes injuries related to these sports are unavoidable. Issues like concussions and orthopedic injuries are commonly discussed, but did you know there are also very serious urological injuries young athletes can experience? To help you and your children prepare in case the worst happens, we’re discussing common pediatric urological injuries from popular children’s sports.

How common are sports related genitourinary (GU) injuries?

Genitourinary trauma includes injuries to the kidneys, bladder, and genitals (testes, vagina, and penis) is reported to represent an important 10% of all pediatric traumas. Notably, emergency room and hospital-based national injury and trauma registries have identified sporting injury as the cause of one-third of genitourinary injuries in children thereby making it the most common cause of pediatric GU injury. Trauma registries may actually underestimate the real number of injuries because they do not include less serious injuries treated in outpatient clinics and physician’s offices.

What sports activities are most likely to produce genitourinary trauma in pediatric patients?

Involvement in sports activities can be an important part of a child’s development. Knowing which activities are more likely to be associated with injuries helps parents and children become more aware and take proper precautions while still enjoying sports participation. For instance, one-third of genitourinary sports-related injuries occur with bicycling making it the most common activity associated with genitourinary injury. The majority of kids enjoy bike riding so it is not surprising that this activity tops the list. Also, the riskier form of biking including off-road biking and extreme sport biking are becoming more popular.

Injuries related to team sports such as football, baseball or softball, basketball, soccer, and lacrosse are also common, particularly among boys, and combined these activities represent another third of all injuries. Kicks to the groin, helmet contact, or the impact of a fast-moving ball as with baseball or lacrosse can cause serious damage to the testicles. The most serious injuries to the testis occur when the testis is hammered against the pubic bone resulting in a contusion, bleeding inside the scrotum, fracture or rupture of the testis. Some injuries may not be correctable and may result in loss of a testicle. Fortunately, most patients that sustain injuries with team sports are evaluated and treated in the ED without inpatient admission.

How Can Common Pediatric Urology Sports Injuries be Avoided?

Genitourinary injuries from bicycles are usually from falls or straddle injuries and most bike injuries occur from collisions with the “top bar” or the handlebar. Using a properly fitted bike, properly padded seats, padded top bar and attention to speed and surroundings will lessen the likelihood of jury.

Boy athletes that are participating in contact sports including football, soccer, baseball, basketball, lacrosse, and hockey should wear an athletic cup made of hard plastic or metal. Boys should begin to wear a cup as soon as they are big enough for one to fit – usually around age 6 to 8. Proper fit is crucial and the cup must be held in proper position by an athletic supporter, jock strap or compression shorts designed to be fitted with a cup. The cup should fit firmly against the body and not shift out of place during activity. If your son is involved in a non-contact sport that involves lots of running, a jock strap or compression shorts without a cup are sufficient and will help keep the penis and scrotum up and out of the way. If you are uncertain what your son should be using, ask a knowledgeable coach or athletic trainer.

What are the Signs and Symptoms of Common Pediatric Urology Sports Injuries?

Blood in the urine or at the opening of the urethra, inability to urinate, flank or abdominal pain, or swelling, bruising and tenderness of the external genitalia usually accompany genitourinary injury. To reduce the morbidity of the injury it is important to quickly identify and properly manage genitourinary injuries. If an injury has occurred there should not be any delay in getting medical attention for your child. Imaging with X-rays, ultrasound, CT may be necessary to fully assess an injury. While most injuries are managed with monitoring and supportive care and only a few with surgical treatment the determination of the best treatment can only be made after careful evaluation.

Special circumstances: Can my child who has a solitary kidney or testis still participate in contact sports?

Yes, boys with a single testicle or a history of an undescended testicle can participate in contact sports if they wear a protective cup. For children with chronic kidney disease or a solitary kidney, the current policy statement by the American Academy of Pediatrics is a “qualified yes”. This recommendation stems from the recognition that kidney injuries during contact sports are uncommon and catastrophic kidney injuries are even rarer. However, parents of children with kidney problems or solitary GU organs should carefully consider the risks and benefits of their child’s participation in a contact sport and make an informed decision only after consulting with their child’s pediatrician and urologist.

If you have any more questions or concerns about common pediatric urology sports injuries, click here to schedule an appointment with an expert Georgia Urology pediatric urologist.

Percutaneous Nephrolithotomy (PCNL)

Two plastic kidneys with PCNL on a table with two stereoscopes.

By Dr. Jerry Yuan, M.D.

Percutaneous Nephrolithotomy (PCNL) is the procedure of choice when dealing with large bulky renal stones, especially those of dense consistency.

Standard treatments for routine kidney stones, such as shock wave lithotripsy or endoscopic removal via mini-endoscope through the ureter, are effective in dealing with most stones. However, when confronted with large stones of 1-2 cm or more in size compounded by those of very hard chemical makeup, more definitive steps are required. This is where PCNL comes in.

How Does PCNL Work?

PCNL allows for direct contact of the offending stones with full-size endoscopes & lithotripsy (stone busting) devices and simultaneous removal of fragments to achieve the most expedient & complete stone clearance.

During PCNL, an access or accesses are placed by our radiology specialists in the flank.

Xray of Percutaneous Nephrolithotomy, Needle and access placement

Once in place, the access is then dilated to allow placement of working ports gaining entry into the plumbing system of the kidney where stones reside. Various devices including laser, ultrasound or pneumatic jackhammer like probes are then used to disintegrate the stones, sizable fragments are easily evacuated without the need for the passage which often is not feasible when dealing with a large amount of debris.

Videos of PCNL

Three videos are provided to illustrate the large stones we often encounter or the so-called staghorn stones since they take up the entire interior of the kidney.

Video one is Before.

Video 2 is multiple sessions in progress with marked reduction of stone burden and multiple drainage catheters in place.

Video 3 is post-op with minimum debris remaining.

PCNL typically requires overnight stay and most patients are treated with a single session. Some require multiple sessions days apart to effect a satisfactory result.

If you have any more additional questions about PCNL, click here to contact any of our Georgia Urology experts.

Georgia Urology Adopts Groundbreaking Enlarged Prostate Surgery

Male doctor checking another male patient by pressing into his side as he lays down, checking for enlarged prostate to see if the groundbreaking enlarged prostate surgery is necessary.

Georgia Urology’s Dr. Brent Sharpe counts himself fortunate to not only witness revolutionary breakthroughs in his field, but to be a purveyor himself.

When treating patients for benign prostate hyperplasia (BPH), otherwise known as prostate enlargement, Dr. Sharpe can now offer the option of the groundbreaking enlarged prostate surgery Aquablation TURP, a game-changing urological procedure. Georgia Urology is the first practice in three surrounding states to perform the surgery.

BPH is a very common condition in which the prostate grows and obstructs the flow of urine. Its effects on the urinary system include decreased flow, difficulty starting the flow, starting and stopping during urination, frequency, urgency, and commonly getting up at night to use the bathroom.

Aquablation TURP by Procept BioRobotics utilizes the clarity of real-time multidimensional imaging, the accuracy of an autonomous robot, and the power of a heat-free water jet to produce a more reliable and predictable surgery. The use of real-time ultrasound permits for key structures to be identified to allow for normal sexual function and continence, as well as to determine the exact size and shape of the prostate.

The automatic robotic device allows for faster and more predictable removal of tissue. In fact, operative times may be reduced as much as 50 percent. Finally, by not using heat energy during the procedure there is a reduction in the typical complications associated with standard TURP.

“It’s really revolutionizing robotic surgery for men with benign prostate hyperplasia,” Dr. Sharpe says, “ which may make other forms of transurethral surgery obsolete.”

After suffering from an enlarged prostate for approximately 12 years, Roger Lance of Buford, Georgia opted for Aquablation TURP and walked away astonished by the results.

Lance says the high-pressure saline stream basically obliterated the obstruction quickly and efficiently. The surgery itself only required an overnight hospital stay. After a one- to two-week recovery period, Lance says he regained bladder control, and things improved greatly.

“I haven’t been able to go to the bathroom like this since I was a teenager,” Lance says. “It’s just amazing how much it changed everything.”

Millard Hixson of Toccoa, Georgia echoes the same sentiment. With an enlarged prostate four times larger than normal, Dr. Sharpe suggested they take action. Hixson chose Aquablation TURP.

“I couldn’t imagine the procedure going as good as it did,” he says. “It’s made a big difference. I don’t get up at night anymore, and I’m able to sleep a lot better. I didn’t realize how much continuous sleep night was important. Now I can sleep for seven to eight hours straight. I have a lot more energy now.”

According to Dr. Sharpe, providing this type of relief and lifestyle change to patients via groundbreaking technology remains one of the most rewarding aspects of his career as a urological surgeon.

“Every patient I’ve worked with has experienced a significant reduction in symptoms, and they’re extremely satisfied,” Dr. Sharpe says. “As a surgeon, you can’t hope for a better outcome than that.”

For more information, you can contact Dr. Sharpe at 678-205-8387 or click here to schedule an appointment.

Varicoceles in Children and Adolescents: When and How to Treat?

White blonde little boy around six at the doctor's office. He is with his mom behind him and the doctor is in front of him, examining him and discussing varicoceles in children.

By Andrew J. Kirsch, MD, FAAP, FACS

Physicians and parents alike are challenged by the management of varicoceles in children.  This blog is meant to frame the controversy and educate our patients and families on the current state of the art.  As will soon become obvious, shared decision-making is particularly important when considering the many questions that 15% of the male population and their parents need to consider. The first question below is a big question and charged in controversy.

Do adolescent varicoceles have a progressive harmful impact on male fertility?

 

A graph for varicoceles in children. Five blue text boxes in a row. The first says "adolescent varicoceles", the second says "testicular volume", the third says "semen parameters", the fourth says "hormone alterations", and the fifth says "male fertility". Each box has an arrow pointing to the next, and, to the left is a swooping line that includes all of the boxes with a question mark in the middle.

Determining the effect on future fertility is challenging for a variety of reasons

  • Limitations in obtaining/interpreting semen analysis
  • Unequal differential testicular growth during puberty regardless of varicocele
  • A long lag time between varicocelectomy and attempt at paternity
  • To add to the confusion, there are no current professional guidelines for children and adolescents

There are 2 main debates among expert pediatric urologists.  The first is whether we should treat a varicocele surgically.  Here are the issues:

The debate to treat is supported by these facts:

  • Varicocele is the most common correctable cause of male infertility
  • Corrective surgery (varicocelectomy) improves semen quality

The debate not to treat is also supported by facts:

  • Men with varicoceles father children
  • Semen quality does not always mean there be a successful pregnancy

The second debate focuses on when to treat a varicocele. Here are the pertinent questions:

Do we treat all adolescents with large varicoceles and smaller testis on the same side?  If so, would we overtreat? Or, do we wait and only treat the infertile man trying to start a family? If so, are we too late? Will success be lower? These are the questions that are likely to torment parents of boys with varicoceles.

Here is some data that may help

In the pediatric age patient, the size or volume of the affected (left) testis compared to the normal side is key to helping identify who is at risk for future infertility.  Or is it?  There are many studies on both sides of this long-standing debate. Larger testis volume differences are associated with significantly lower sperm concentration and motility regardless of patient age or varicocele grade.  What is the testis volume loss of boys with varicoceles compared to boys without varicoceles?  A study looking at >400 affected boys compared to 70 normal boys showed that those with grade 3 varicoceles had left testis volume loss at all stages of puberty, but also right testicular volume loss compared to controls. In other words, both testes can be affected.

Many studies show that varicoceles are not progressive – they don’t get worse – and catch-up growth occurs without surgery.  However, in one study of 100 boys with an average age of 15 years, testicular volume differences > 20% lead to 2x odd of a lower total mobile sperm count.  The same study showed total testicular volume (TTV = right + left) <30cc lead to a 4x odds of a lower sperm count.  Almost all studies have shown that there does not appear to be any association between testicular volume loss and hormone abnormalities.

So, we have decided that surgery would be the best approach.  Is there a difference in outcomes?

When deciding upon differences in surgical approach – laparoscopic (Palomo), microscopic, or open groin incision, there is no good data to support one approach over another.  The rates of hydroceles (fluid around testis) or recurrence are generally low (<10%).

Let’s summarize Varicoceles in Children:

The dilemma regarding pediatric varicoceles comes down to these facts:

  • Our tools to identify subfertility are imperfect
  • Your urologist needs to evaluate all meaningful data
    • Testis size (TTV <30cc, TVD >20% )
    • Semen analysis when available
    • Status of “normal” testis
    • Hormone levels (not meaningful in young age)

Parental preference is key.  There’s no doubt about it – shared decision-making is critical to the management of varicoceles.  Advice to parents:  For the majority of boys with varicoceles it makes good sense to follow prospectively and treat conservatively.

Treatment and Prevention of rUTI in Women

White woman with short brown hair sitting with doctor in an office, discussing rUTI.

By Dr. A. Keith Levinson, M.D.

Symptomatic, recurrent lower urinary tract infections (rUTI) in women are a common condition for which best practice guidelines related to treatment and prevention have not been well established. rUTi affects women of all ages and is defined as 2 or more symptomatic episodes in 6 months or 3 episodes in 1 year. Between 20% to 30% of women who have one UTI will have a rUTI, and approximately 25% of these women will have more recurrent episodes.

Symptoms of rUTI may typically include burning with urination, foul smelling urine, urinary urgency, and frequency. Treatment strategies should focus on relieving symptoms while at the same time preventing the overuse of antibiotics, which can cause increased side effects as well as the development of antibiotic resistance.

Who is at risk or rUTI? 

  • For premenopausal women, sexual activity can be associated with rUTI.
  • Birth control products such as nonoxynol-9 spermicide can be a risk factor as well.
  • Lack of estrogen in postmenopausal women can lead to vaginal atrophy, acidic PH changes, and overgrowth of bacteria leading to UTI

What type of work up is needed to treat rUTI?

A urine culture prior to treatment with antibiotics is important to document infection and help determine optimal antibiotic treatment. More complex cases may require renal imaging or cystoscopy.

How is rUTI best treated? 

Short course treatment of 3-5 days is recommended. Preferred first line antibiotics are Nitrofurantoin, Trimethoprim-Sulfa, and Fosfomycin. Fluoroquinilones such as Cipro are discouraged.

rUTI prevention strategies:

Some prevention strategies include lifestyle and behavioral modifications:

  • controlling blood glucose in diabetics is important
  • Sexually active women should avoid spermicide gel use. It is unclear whether voiding after intercourse is useful
  • Avoid unnecessary or prolonged antibiotic use (more than 5 days)
  • maintain adequate hydration

There are also therapeutic interventions, such as antibiotic treatments:

  • The use of antibiotic prophylaxis may sometimes be indicated and can be done in several ways.
    • The use of a single low dose antibiotic immediately after intercourse can be very effective in preventing.
    • Once daily low dose antibiotics for 6-12 months may be required at times and is effective.
    • A patient self start 3 day course of antibiotics can be a convenient way to treat intermittent It is best to get a urine culture prior to starting treatment.

Nonantibiotic therapy: 

While commonly used to prevent rUTI, there is little data to support the use of Cranberry products or D-mannose. The value of oral and vaginal probiotics is questionable.

Vaginal estrogen therapy reduces vaginal PH, reduces bacterial colonization, restores lactobacillus, and reduces rUTI in postmenopausal women. There is no documentation of increased breast cancer risk or rise in serum Estrogen levels. Oral estrogens do not reduce UTI risk.

Methenamine Hippurate :

This is a bacteriostatic agent that increases urinary levels of formaldehyde. It does not promote antibiotic resistance. There is some evidence that using methenamine as prophylaxis may help prevent rUTI and reduce need for prophylactic antibiotics.

Vaccines: 

OM-89 (Uro-Vaxom) is an oral vaccine only available in Europe. It appears to be safe and effective in reducing rUTI. Hopefully, this will available in the U.S. soon

rUTI’s are frustrating for women and can significantly impact quality of life, and daily activities. Identifying underlying risk factors is important. There are potentially preventive measures worth discussing with your doctor.

If you have any more questions about the treatment and prevention of rUTIs in women, click here to schedule an appointment with a Georgia Urology expert today.

Common Questions about Urinary Control after Prostate Surgery

Portrait of happy woman surgeon standing in operating room, ready to work on a patient, ready to discuss Urinary Control after Prostate Surgery.

Expert urologist Dr. John Stites, M.D., answers the most common questions about urinary control after prostate surgery below.

Is it common to have urinary control issues after prostate surgery?

Recovery of urinary control is one of the most common concerns for men undergoing treatment for benign and malignant prostate disorders. While most men experience significant improvement or resolution in urinary symptoms, they remain a common source of stress before and after surgery.

Why do men have problems with urinary control after prostate surgery?

It might seem counter-productive that men may have issues controlling their urination after prostate surgery, especially since many men undergo surgery to treat their urinary symptoms to begin with. The underlying causes of these symptoms aren’t limited to the prostate itself; often other structures such as the bladder or urethra can undergo changes after surgery.

For example, a man may undergo surgery to reduce obstruction from his prostate gland so that he may more easily pass urine. Before surgery, his bladder must push harder than usual to pass urine beyond his prostate gland. When this obstruction is surgically removed, however, the bladder must adjust to changes caused by surgery. An unusual urge to urinate with or without leakage may occur during this recovery.

What changes in my urinary control can I expect after prostate surgery?

Individual changes after surgery cannot always be predicted, but there are many tools to help us identify those at risk for urinary control issues after surgery. Before surgery is performed, testing may be needed to determine the functional and structural characteristics of the urinary tract. This information helps us identify men at risk for postoperative urinary control issues.

Who is at higher risk for problems with urinary control after prostate surgery?

More invasive procedures (such as radical prostatectomy for prostate cancer) carry a higher risk for urinary control issues postoperatively. Many factors can influence urinary control after surgery, including underlying medical conditions, medications, diet, and daily activity. Many of these factors are modifiable, and improvement is often achieved by a comprehensive and motivated approach.

It is important to ask your urologist about urinary control when considering prostate surgery, and to discuss pre-existing urinary control issues. Patient education and motivation are among the most important factors in improving urinary control after prostate surgery.

If you have any additional questions regarding urinary control after prostate surgery, click here to contact our expert team.