About one-third of prostate cancer patients opt for the most aggressive surgery available—a radical prostatectomy that removes the entire prostate gland—because that type of surgery cuts the odds of prostate cancer recurrence more than any other treatment.

One downside, though, is that men who choose this type of surgery risk experiencing serious side effects, including urinary incontinence.

What’s worse, recent research shows that this particular side effect isn’t always mild or short-lived. It can linger and become more severe as men age, causing some men to need yet another operation—this time on their bladders.

So if you’re considering a radical prostatectomy or have had one in the past, the following information is vital for you—there is some important and surprising information that could help you…


First off, you’re probably wondering how many patients need bladder surgery after a radical prostatectomy and when, exactly, urinary incontinence might become severe post-op. I got answers from lead researcher Robert Nam, MD, who analyzed the medical data of more than 25,000 radical prostatectomy patients.

A trend emerged within the statistics. The number of men having urinary incontinence surgery (bladder surgery) nearly doubled over a 10-year span, going from 2.6% at five years post-prostatectomy to 4.8% at 15 years post-prostatectomy.

On top of that, men who had had both prostatectomy and radiation treatment—which is known to irritate the bladder—were even more likely to end up needing bladder surgery.


A radical prostatectomy removes not only the prostate but also one of the two sphincters that help men command their urine flow, leaving them with only one, Dr. Nam told me. Based on anatomy and current technology, there’s no way to avoid this. That’s not a problem for most men, who can readily use their remaining sphincters to adequately control their bladders. But with more prostate cancer survivors living longer—a happy result of prostatectomies—comes more men coping with overactive bladder syndrome, an age-related condition that prompts frequent urination. Overactive bladder syndrome is hard to deal with when a man has two sphincters, but it’s especially troublesome with only one.

Put those two problems together and you’ve got a recipe for needing bladder surgery. This particular surgery involves the insertion of a prosthetic device, either an artificial urinary sphincter or a urethral sling. As with any surgery, it comes with some risks, such as infection, bladder perforations and/or damage to the urinary tract. Due to those risks, it’s considered a last resort after other treatment strategies (such as drugs and Kegel exercises to strengthen the remaining sphincter fail). “But it’s highly successful in reversing incontinence—plus, men are usually back home on the same day of the surgery and up and running again after a week of recovery,” said Dr. Nam. So while getting a second surgery may be an unpleasant surprise for prostate cancer survivors, at least this is one surgery that’s generally considered to be very safe and very effective.


So men, if you’ve had a prostatectomy and you’ve started to experience urinary incontinence, know that it’s likely to get worse—not better—and that you may need bladder surgery someday. And if you have prostate cancer and are considering a prostatectomy, Dr. Nam offered an important recommendation based on his study findings. Make sure that your surgeon performs at least 49 prostatectomies each year—because men using such experienced surgeons were only about half as likely to end up having bladder surgery as men whose surgeons performed fewer procedures. This is one case where it seems clear that the experienced surgeons, on average, are simply doing a better job.