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Hi in this video we'll continue talking about the problem of urinary incontinence after
prostate surgery, there are two main surgeries that can cause incontinence in men both related
to the prostate, the first one is called theTURP which stands for transurethral resection of
the prostate, this is a procedure that is usually done for a benign reasons, if you
imagine the water pipe as a tunnel that goes through a mountain, the mountain being the
prostate, so any enlargement of the prostate that grows inwardly can cause obstruction
to that tunnel so the idea of the TURP is to widen that tunnel again by taking chips
of the prostate where the obstruction lies and removing them away, during the process
of performing this some damage can happen to the sphincter muscle because it's just
below the prostate, and that results in a leakage of urine or incontinence in about
5% of men afterwards. The second main reason for causing incontinence in men also related
to the prostate is radical prostatectomy, this is a surgery that is usually done for
cancerous reasons, the surgery aims to remove the whole prostate gland with the aim of curing
patients and because the procedure is much more invasive than the TURP, then, the likelihood
of damage to the sphincter muscle is higher and the percentage of incontinent men afterwards
is also higher, so in this video we'll outline the number of radical prostatectomies that
are performed each year in the UK and USA and based on the likely percentage of incontinent
men afterwards we can conclude the crude number of incontinent men after radical prostatectomy
each year in both countries. So we saw from the slides that
the problem of urinary incontinence is quite a
problem of a large scale and the important question here is that; do all patients with
prostate cancer need to have prostate surgery, now the answer to this question is quite difficult
because there is a lot of research at the moment into trying to find out what is considered
as clinically significant prostate cancer and what is considered as clinically insignificant
cancer, there is already a classification system which is known as the D'Amico classification
where prostate cancer is defined into low risk, intermediate risk and high risk based
on the aggressiveness of the cells and the level of the PSA and also the volume of the
cancer is taken into consideration when considering treatment for prostate cancer, however even
when using this system a lot of patients who are considered as low risk are offered prostate
surgery and this trades their low risk cancer with a life-long problems with urinary incontinence
and erectile dysfunction so the main research question now is how can we define clinically
significant prostate cancer accurately and what kind of threshold we need to have to
trigger treatment. Hopefully the future will bring more answers or more clear answers to
this question and less patients will have to undergo prostate surgery if they have very
insignificant prostate cancer that could just simply be watched by doing serial PSA blood
test and serial imaging like MRI or a repeat biopsy if need be. Thank you.