Managing Urinary Issues After Prostate Cancer Surgery: A Patient's Guide - Urology

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Managing urinary issues after prostate cancer surgery can be a complex process, especially when complications arise such as urinary retention or incontinence. In your father's case, he has undergone a Da Vinci robotic surgery for prostate cancer (T3A) and subsequently experienced urinary difficulties, including a narrowing of the urethra that required an endoscopic procedure. This situation is not uncommon, as surgical interventions on the prostate can lead to various urinary complications.

Firstly, it is essential to understand that urinary issues post-prostate surgery can manifest in several ways, including urinary incontinence, urgency, frequency, and retention. The use of medications like Minirin (desmopressin) is typically aimed at managing nocturia (nighttime urination) and can sometimes lead to decreased urine output, which may not be suitable for all patients. If your father experienced a reduction in urine volume and subsequently stopped the medication, it is crucial to monitor his urinary patterns closely.

The concern regarding the recurrence of urethral stricture (narrowing) is valid. Urethral strictures can develop after surgical procedures due to scar tissue formation. Symptoms of a stricture may include decreased urine flow, difficulty starting urination, and post-void dribbling. If your father is experiencing these symptoms, it would be prudent to discuss the possibility of a stricture with his urologist. Diagnostic imaging, such as a retrograde urethrogram or cystoscopy, may be necessary to confirm the presence of a stricture.

Regarding the PSA (Prostate-Specific Antigen) levels, it is important to note that after prostate surgery, PSA levels should ideally decrease significantly. An increase in PSA levels post-surgery can indicate residual prostate cancer or other complications. The need for an MRI scan is a standard procedure to assess for any potential recurrence or metastasis, especially if there are concerning symptoms or rising PSA levels. While the MRI itself should not directly affect urinary function, it is essential to communicate any ongoing urinary issues to the healthcare provider before the scan.

In managing urinary issues post-surgery, several strategies can be considered:
1. Behavioral Techniques: Bladder training and pelvic floor exercises (Kegel exercises) can help improve urinary control and reduce urgency.

2. Medications: If Minirin is not suitable, other medications may be prescribed to help manage urinary symptoms. Anticholinergics or beta-3 adrenergic agonists can be effective for overactive bladder symptoms.

3. Surgical Interventions: If a urethral stricture is confirmed, further surgical intervention may be necessary to correct the narrowing. This could involve dilation or urethroplasty, depending on the severity and location of the stricture.

4. Follow-Up Care: Regular follow-up appointments with the urologist are crucial to monitor PSA levels and urinary symptoms. Adjustments to treatment plans can be made based on ongoing assessments.

5. Patient Education: Understanding the potential side effects of treatments and the importance of reporting any new or worsening symptoms can empower patients to take an active role in their care.

In conclusion, your father's urinary issues following prostate cancer surgery warrant careful evaluation and management. It is essential to maintain open communication with his healthcare team, ensuring that all symptoms are reported and addressed promptly. By taking a proactive approach, it is possible to improve his quality of life and manage the complications associated with prostate cancer treatment effectively.