In men, what is a common cause of post-prostatectomy incontinence and a typical initial management option?

• A. Incontinence due to overactive bladder; initial management is antimuscarinics
• B. Incontinence due to prostate cancer recurrence; initial management is radiation therapy
• C. SUI due to sphincter deficiency after prostate surgery; initial management includes pelvic floor exercises and possibly devices like a male sling or AUS after failure of conservative therapy
• D. Incontinence due to bladder outlet obstruction; initial management is alpha blockers

Answer: (C)

Post-prostatectomy incontinence in men is most often due to weakness or damage of the external urethral sphincter, causing intrinsic sphincter deficiency after the prostate surgery. The best initial approach is conservative therapy with pelvic floor muscle training to strengthen the sphincter and surrounding pelvic floor, sometimes aided by biofeedback. This noninvasive first step works well for many men. If leakage persists after several months of optimized conservative therapy, surgical options are considered, such as a male sling to provide support or compression of the urethra, or an artificial urinary sphincter for more severe or persistent incontinence. This pattern fits the scenario of sphincter deficiency after prostate surgery and the progression from pelvic floor exercise to possible implantable devices if conservative measures fail.