The patient is a 67-year-old man who underwent an open radical prostatectomy in 2014 for prostate cancer. Since the surgery, he has experienced urinary leakage when walking or coughing. Testing revealed mild hydroureteronephrosis but no strictures or leaks. The patient was advised conservative management with follow up in 6 months before considering an artificial urinary sphincter, due to the mild hydroureteronephrosis.

1. Post radical prostatectomy
Urinary Incontinence

2. History
• 67 years Gentleman
• Poor flow, frequency 4 years back
• No urgency, hematuria, AUR or incontinence
• Diagnosed to have carcinoma prostate
• Open radical prostatectomy for carcinoma prostate
March 2014

3. • Post operatively - poor flow of urine, straining and
urinary leakage at walking, coughing .
• No leakage at night.
• EIU for anastomotic site stricture – October 2015
• H/O TURP in 1995, Bilateral hernioplasty 2015
• No co-morbidities

5. Examination
• General physical examination was unremarkable.
• Pulse 84/min. BP 120/80 mmHg
• PA: Lower mid line scar and bilateral hernioplasty
scar. Bladder not palpable.
• External genitalia: EUM, testes & cord structures
were normal.
• DRE: Tone normal with positive BCR & prostate not
felt.

7. Investigations
• Hemoglobin: 14.8 gm/dl
• TLC: 6700 / cumm
• Creatinine : 0.9 mg %
• Urine R/M: Normal
• Urine C/S : No growth
• PSA : < 0.04 ng/dl

8. Uroflowmetry
Q max = 10 ml/sec, Voided volume 266 ml, PVR = 90 ml

9. Ultrasound KUB
Kidneys Bladder

10. MCU
Scout RGU

11. MCU
RGU Full Bladder

12. MCU
Micturating Post void

13. • USG report:-
• Bilateral mild hydroureteronephrosis
• MCU report:-
• No strictures or leak

15. Management
• Conservative :
– In view of mild HUN , advised to follow up after 6
months before planning of artificial urinary
sphincter.

17. Learning Points
• Causes
• How to prevent it?
• management