@christophers

Does surgery result in urine leakage...?

Answer, it can. Then again, when my catheter came out after surgery, zero incontinence and to be honest, I didn't do any Hegel exercise before or after!

Urinary incontinence is a common, usually temporary side effect of prostate removal(radical prostatectomy), with most men regaining control within 3–12 months. It results from damage to nerves or muscles controlling the urinary sphincter during surgery, leading to involuntary urine leakage, primarily through stress or urge incontinence, which may require pads or specialized exercises to manage.
Key Types of Incontinence After Prostate Removal
• Stress Incontinence (Most Common): Leakage occurs during physical activity, such as coughing, sneezing, lifting, or laughing, due to weakened muscles supporting the urethra.
• Urge Incontinence: A sudden, uncontrollable need to urinate, often caused by bladder spasms.
• Continuous Leakage: A severe, less common form where urine leaks constantly.
Causes and Factors
• Damage to Sphincter/Nerves: The prostate wraps around the urethra, and its removal can damage the external sphincter muscle and surrounding nerves, which are critical for holding urine.
• Shortened Urethra: The urethra is slightly shortened during the reattachment process.
• Healing Process: Swelling or damage from surgery disrupts normal bladder function.
Recovery and Management
• Timeline: While most men see improvement in 3–6 months, some may take up to a year or more to regain continence.
• Pelvic Floor Exercises (Kegels): These are essential to strengthen the remaining muscles to take over the role of the sphincter.
• Prognosis: Approximately 10–15% of men report frequent leakage or the need for pads 6 months after surgery.
Long-Term Complications
• Permanent Incontinence: In rare cases (roughly 5-8% of men), incontinence can be permanent or last longer than a year.
• Urethral Strictures: Scar tissue may cause a narrowing of the urethra months or years later, which can alter urine flow and cause new incontinence issues.
• Surgical Interventions: If conservative methods fail, options include artificial urinary sphincters or male slings.

Bowel leakage...? I don't have the experience or layman's degree of expertise to say.

Ditto for the PI- RADS

As to the tests, that depends too. Some medical professionals are slow to adapt to changes brought about by medical research.
There may be insurance issues.
There may be a concern that those tests are not necessary or "over testing."

Do your homework on these tests so you "understand" them.

Consider sending a note through your patient portal saying these are the things you would like to talk about at your next consult, specifically, will these tests help answer the question:

Do I have PCa?
Is there clinical data sufficient to determine if we need to consider treatment?

Kevin