Urinary Incontinence After Prostate Biopsy: Causes and Concerns

Prostate enlargement biopsy urinary incontinence

1.
Due to benign prostatic hyperplasia, my PSA level is 6.24.
This is following my first biopsy three years ago (September 2018, PSA 6.38) and a continuous medication regimen with Alfuzosin.
On December 12, 2022, I underwent a second prostate biopsy.
After waking up from anesthesia, I noticed a significant amount of blood, visually estimated to be under 100cc, which startled me since there was hardly any bleeding after the first biopsy.
After leaving the hospital, I did not experience any further bleeding.

3.
On January 6, 2023, I visited a local health clinic.
During bowel movements, I noticed some straining at the anus, and there was still a faint trace of blood mixed with urine dripping from the urethra.
The doctor ordered blood tests and a urinalysis.
The C-reactive protein (CRP) level was >1.90, indicating elevated inflammation, and the urinalysis showed no bacterial growth in 48 hours.
The doctor prescribed some antibiotics.
4.
Starting January 15, 2023, I began experiencing urinary leakage from the urethra, even without any sensation, with small amounts of urine leaking out.
It feels like I need to be on guard against unexpected leakage at any moment.
5.
I would like to ask the doctor:
a.
As of today, January 19, 2023, after so many days, why is there still a faint trace of blood mixed with urine during bowel movements?
b.
Why am I experiencing this urinary incontinence after the prostate procedure, which I have never had before?
c.
Could the biopsy process have caused damage to the sphincter or nerves?

Shifang, 60~69 year old female. Ask Date: 2021/01/19

Dr. Li Minghui reply Urology

The apex of the prostate is close to the sphincter, and the nerves enter the prostate and sphincter from both sides externally.
Although standard biopsies typically do not reach the apex or the sides directly, which would harm the sphincter or nerves, inflammation can occur near the path taken by the biopsy needle.
If there is significant bleeding or an infection occurs, the extent and duration of the impact may be greater.
Past studies have shown that the rate of minor bleeding lasting more than four weeks can be as high as 30%, and if an infection has occurred, it may also slow wound healing.
The report did not mention any cases of urinary incontinence following the biopsy; rather, urinary retention (inability to urinate) was more common.
It cannot be ruled out that incomplete emptying of the bladder could lead to overflow incontinence.
In previous cases, almost all complications were temporary, and even if they lasted longer, they typically resolved on their own.
Regular follow-up appointments are recommended to ensure that no infections or other conditions that could worsen symptoms have developed, while also monitoring recovery progress.

Reply Date: 2021/01/19

More Info

Urinary incontinence following a prostate biopsy can be a concerning issue for many patients. In your case, it seems that you have experienced a series of symptoms following your second biopsy, including blood in the urine and leakage. Let's break down the potential causes and concerns related to your situation.

1. Causes of Urinary Incontinence After Prostate Biopsy:
- Trauma to the Urethra or Surrounding Structures: During a prostate biopsy, needles are inserted through the rectum to obtain tissue samples from the prostate. This procedure can sometimes cause trauma to the urethra or the surrounding structures, including the sphincter muscles that control urination. If these muscles are affected, it can lead to urinary incontinence.

- Inflammation and Infection: The biopsy can also lead to inflammation of the prostate (prostatitis) or urinary tract infections (UTIs), which can cause symptoms such as urgency, frequency, and incontinence. Your report of blood in the urine and the presence of bacteria (even if no growth was noted) suggests that inflammation or infection could be contributing to your symptoms.

- Nerve Damage: Although rare, there is a possibility that nerves controlling bladder function could be affected during the biopsy, leading to incontinence.

2. Concerns Regarding Blood in Urine:
- It is not uncommon to experience some bleeding after a prostate biopsy. However, if you continue to see blood mixed with urine days after the procedure, it is essential to monitor this closely. Persistent bleeding could indicate a complication such as a hematoma or infection.

- The presence of blood during bowel movements could also be related to straining or could indicate another issue that should be evaluated by your healthcare provider.

3. Duration of Symptoms:
- It is important to note that while some bleeding and discomfort can be expected after a biopsy, ongoing symptoms such as incontinence or blood in the urine should be evaluated further. If these symptoms persist beyond a few days, it is advisable to follow up with your urologist for further assessment.

4. Next Steps:
- Follow-Up Appointment: Schedule a follow-up appointment with your urologist to discuss your ongoing symptoms. They may recommend additional tests, such as a urinalysis or imaging studies, to rule out any complications.

- Monitoring Symptoms: Keep track of your symptoms, including the frequency and amount of leakage, any changes in urine color, and any pain or discomfort. This information will be helpful for your doctor in determining the best course of action.

- Medication Review: Discuss any medications you are taking, as some medications can contribute to urinary incontinence. Your doctor may adjust your treatment plan based on your symptoms.

5. Seeking a Second Opinion:
- If you have concerns about the management of your symptoms or the initial diagnosis, seeking a second opinion from another urologist can provide additional insights and reassurance.

In conclusion, urinary incontinence following a prostate biopsy can arise from various factors, including trauma, inflammation, and nerve involvement. It is crucial to communicate openly with your healthcare provider about your symptoms and concerns to ensure appropriate management and follow-up. Regular monitoring and follow-up appointments will be key in addressing any ongoing issues and ensuring your recovery.

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