Reconstructive Urology

Male Urinary Incontinence

Incontinence occurs when a person involuntary leaks urine. Male urinary control issues and leakage are often a result of prostate cancer therapy. Surgery, radiation and alternative therapies can result in urinary sphincter muscle dysfunction. Post-prostatectomy urine leakage, or stress incontinence, typically occurs with straining activities and physical exercise. This type of leakage is generally caused by a weak or damaged urinary sphincter—the muscle that acts as a valve controlling the flow of urine out of the bladder. If the sphincter is not closing properly, the individual will leak urine.

Many men experience temporary leakage after prostate surgery. Generally, this is short-lived and resolves with pelvic floor exercises and time. By six to 12 months after surgery, most spontaneous recovery has occurred. Patients who still leak after this period may need to consider surgical repair.

Stress urinary incontinence can be caused radical prostatectomy for cancer, radiation to the prostate or bladder, enlarged prostate surgery and other procedures. It can also be caused by neurologic disorders, spinal cord injuries, pelvic trauma or pelvic surgery.

Non-surgical treatment options include fluid restriction, avoiding bladder irritants (such as caffeine, alcohol, artificial sweeteners and carbonation), pelvic floor rehabilitation (including Kegel exercises), urethral/penile clamp, catheters and absorbent pads and diapers.

Urethral Sling Surgery

The male sling procedure is a minimally invasive surgical solution for male stress incontinence. This procedure involves the placement of a soft sling of mesh to reposition the urethra and provide support to surrounding muscles. This functions to keep the urethra closed, especially during coughing, sneezing or lifting. The sling is placed entirely inside the body and is completely undetectable.

The surgery is performed through a small incision between the anus and the bottom of the scrotum. The procedure is performed as an outpatient procedure (men go home the same day as the surgery) and generally takes about 45 minutes. Potential side effects include persistent leakage, urinary retention, wound site pain and irritation. In recent studies, 77 percent of men undergoing a male sling placement were classified as cured or improved after the procedure.

Artificial Urinary Sphincter

Patients with moderate to severe urinary leakage usually require the placement of an artificial urinary sphincter (AUS) device. Men who need the device usually leak through more than two to three pads per day and can even have complete incontinence wearing multiple diapers throughout the day and night.

This urinary control system is a three-part device that is completely contained within the body. The hydraulic system consists of a small control pump placed in the scrotum, an inflatable cuff/ring around the urethra and a saline-filled balloon located next to the bladder. This system works by using fluid to open and close the cuff surrounding the urine, mimicking the patient’s own sphincter.

The artificial urinary sphincter has been the gold standard for treating male incontinence for more than 40 years. Well over 180,000 devices have been placed around the world to date. This system can successfully treat all degrees of leakage in men. Published long-term studies have shown success rates of 82-90 percent, regardless of the amount of leakage. The average lifespan of the device is about seven years.