What is a typical non-surgical management option for men with post-prostatectomy incontinence before considering an artificial urinary sphincter?

• A. Pelvic floor exercises
• B. Antimuscarinic medication
• C. Urinary diversions
• D. Immediate AUS

Answer: (C)

The main approach is to start with conservative, non-surgical measures that strengthen and support the continence mechanism. The most common and effective option for men with post-prostatectomy incontinence is pelvic floor muscle training. By correctly strengthening the external urethral sphincter and surrounding pelvic floor muscles, patients can improve urethral closure and reduce leakage, often with a structured program guided by a physical therapist. This kind of therapy is low risk, can be done at home, and serves as a first-line step before pursuing more invasive options like an artificial urinary sphincter.

Urinary diversions, on the other hand, are surgical procedures that reroute urine away from the bladder (for example, creating a conduit or neobladder). They are not considered non-surgical management and are typically reserved for situations where the bladder or continence mechanisms are not salvageable or when other treatments have failed or are unsuitable. Therefore, they are not the typical pre-AUS non-surgical option.