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 follows my first biopsy three years ago (September 2018, PSA 6.38), after which I have been continuously taking medication: 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.

2.
On January 6, 2023, I visited a local health center.
During bowel movements, I noticed some effort 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, which is above the normal range, and there was no bacterial growth in the urine after 48 hours.
The doctor prescribed some antibiotics.
3.
On January 15, 2023, I began experiencing urinary leakage from the urethra, even without any sensation, with a small amount of urine dripping out.
It feels like I need to be on guard against urine leaking out at any moment.
4.
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 experienced before?
c.
Could the biopsy process have caused damage to the sphincter or nerves?

Shifang, 60~69 year old female. Ask Date: 2021/01/20

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 routine biopsies typically do not involve 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 reported that the rate of minor bleeding lasting more than four weeks can be as high as 30%, and previous infections may also slow wound healing.
The report did not mention cases of urinary incontinence following biopsies; rather, urinary retention (inability to urinate) was more common.
It is also possible that incomplete bladder emptying could lead to overflow incontinence.
Historically, almost all complications in previous cases have been temporary, and even if they last longer, they tend to resolve on their own.
Regular follow-up visits are recommended to ensure that no infections or other conditions that could worsen symptoms have developed, while also monitoring recovery progress.

Reply Date: 2021/01/20

More Info

Urinary incontinence following a prostate biopsy can be a concerning issue for many patients, especially when it arises unexpectedly after a procedure that is typically considered routine. In your case, the presence of blood in the urine and the onset of urinary incontinence after the second biopsy raises several important questions regarding the underlying causes and potential long-term implications.

1. Causes of Urinary Incontinence Post-Biopsy:
After a prostate biopsy, it is not uncommon for patients to experience some degree of bleeding and urinary symptoms. The prostate gland is located near the urethra and the muscles that control urination. During the biopsy, the needle may inadvertently irritate or damage the surrounding tissues, including the urethra and the sphincter muscles that help control urine flow. This can lead to temporary incontinence or leakage of urine.
In your case, the fact that you experienced significant bleeding initially, followed by a gradual onset of urinary leakage, suggests that there may have been some trauma to the urethra or surrounding structures during the biopsy. Additionally, inflammation or infection following the procedure can exacerbate these symptoms, leading to further complications.

2. Why Blood and Incontinence Occur:
The presence of blood mixed with urine can be attributed to several factors, including trauma from the biopsy, irritation of the urinary tract, or even an infection. The fact that you are still noticing blood after several days may indicate that the healing process is taking longer than expected, or that there may be an underlying issue that needs to be addressed.

As for the urinary incontinence, it is possible that the biopsy may have affected the sphincter mechanism, leading to a temporary loss of control. This is particularly true if there was any swelling or inflammation in the area. In some cases, patients may also experience urinary retention, which can paradoxically lead to overflow incontinence if the bladder becomes overly full.

3. Potential Damage to Sphincter or Nerves:
While it is unlikely that a standard biopsy would directly damage the sphincter or nerves, it is not impossible, especially if there were complications during the procedure. If you are experiencing persistent incontinence, it may be worthwhile to discuss this with your urologist, who may recommend further evaluation, such as imaging studies or urodynamic testing, to assess the function of the bladder and sphincter.

4. Management and Follow-Up:
It is essential to maintain regular follow-up appointments with your healthcare provider to monitor your symptoms. If the bleeding persists or if the incontinence worsens, further intervention may be necessary. This could include medications to manage inflammation or infection, pelvic floor exercises to strengthen the sphincter, or even surgical options if conservative measures fail.

5. When to Seek Additional Opinions:
If you have concerns about the management of your symptoms or the adequacy of the care you are receiving, seeking a second opinion from another urologist can be beneficial. It is crucial to ensure that you feel comfortable and confident in your treatment plan.

In conclusion, while urinary incontinence and bleeding after a prostate biopsy can be alarming, many cases resolve with time and appropriate management. However, it is essential to remain vigilant and proactive in addressing any ongoing symptoms to prevent potential complications. Regular communication with your healthcare provider will be key in navigating this recovery process.

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