Treatments & Procedures - Surgical
Artificial Urinary Sphincter (AUS) & Male Sling
Last updated: January 20, 2006
Overview
For treatment of male incontinence:
Incontinence in men may occur after surgery on the prostate gland either for cancer or benign prostatic hypertrophy (BPH). It is not uncommon to experience incontinence after having a prostatectomy within the first year after treatment. Kegel exercises are recommended to regain control of the the urinary tract. However, if urinary incontinence persists after one year, a referral to a urologist who is familial with surgical treatment for incontinence should be made.
Prior to have surgery for incontinence, 2 tests are usually recommended:an urodynamics test and a cystoscopy. These are important test in order to determine how weak the urethra is, the quality of the bladder (how much the bladder can hold and at what pressure) and quality of the urethra. There are some men who leak urine because they have high bladder pressures, or overactive bladder, and this condition is not amenable to surgical therapy.
If these test suggests you are a candidate for the surgical procedures, your physician will counsel you regarding the type of surgery that is best for you.
There are three treatments:
- periurethral bulking agent,
- artificial urinary sphincter,
- and the male sling.
Bulking agents can be used by are generally not successful. The advantage of bulking agents are that they can be injected under local anesthesia in the office.
Artificial urinary sphincter
The artificial urinary sphincter (AUS) is a surgically implanted device
that has three components: the cuff which fits snuggly around the urethra
and compresses the urethra except during voiding, the pump which which
is placed inside the scrotum and controls the deflation of the cuff,
and the reservoir which is implanted in an inguinal incision and regulates
the pressure in the cuff (figure 1). When a man wants to urinate, he squeezes
the pump 2 to 3 times until is it completely dimpled, which pulls fluid
out of the cuff releasing the pressure around the urethra. The man voids
and then in 3-5 minutes the cuff automatically reinflates. The AUS has
been used to treat incontinence for 20 year or more. The longterm success
is very good with less than 15% mechanical failure rate at 7.5 years
after implantation. However, some men are reluctant to have such a device
placed because of its complexity and need to "work" something
in order to void.
Male sling
The male sling (figure 2 ) is another alternative than is a very attractive
option for many men who have mild to moderate incontinence yet it is
bothersome to them. This is a surgically implanted of mesh that is anchored
to the pubic bones on each side. It compression the urethra where it
passes underneath the pubic bone to a pressure of about 60cm of water.
This is less complex of a device than the AUS, but very effective for
some men. In a series of men, 40% were completely dry, 40% much improved,
and 20% failed. This is best used in men with moderate incontinence,
and is not as effective in men with severe incontinence. Your doctor
which help you decide which is best for you.
Medications
There are no medication effective against male urinary incontinence as the result prostate surgery or prostate cancer treatment such as radiation or TURP.
Considerations
Anyone who is bothered by their incontinence, and has been experiencing the problem for a year or longer should consider surgical treatment for incontinence.
Effectiveness
Male sling: In a series of men, 40% were completely dry, 40% much improved, and 20% failed. AUS: The longterm success is very good with less than 15% mechanical failure rate at 7.5 years after implantation.
Risks
What are the risks involved with this procedure?
The AUS can become infected or erode through the urethra or scrotum requiring the device be removed. Mechanical failures are possible but have been improved upon over the years. The male sling can also become infected or eroded, these are rare complications. Men may also have difficulty emptying their bladder during the first week or so after the male sling, and need to have a catheter placed to drain the bladder. This also is uncommon.
What are the risks involved with NOT having this procedure?
Quality of life is significantly effected by urinary incontinence, including relationships and body image.
Urgency
No Urgency.
Request an Appointment
At UWMC
Call (206) 598-4294.
For
more information, go to the UWMC Urology Clinic Web page.
At HMC
Call (206) 731-3241
For
more information, go to the HMC Urology Clinic Web page.
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