Stress urinary incontinence (SUI), or bladder leakage, occurs when the urinary sphincter muscle is weakened or damaged and fails to stop the flow of urine during physical activity or movement. Stress urinary incontinence urine leakage can occur with coughing, sneezing or physical exertion. I see this condition most often after prostate cancer surgery, but this type of bladder leakage problem can develop after enlarged prostate surgery, radiation therapy for prostate cancer, pelvic trauma or neurologic disorders. As many as 50% or more of men report leakage immediately after prostate cancer surgery.41 Most of the patients I see heal within the first few weeks to months. However, up to 16% of men will continue to suffer from persistent SUI or bladder leakage one year after surgery.3 Patients who suffer from stress urinary incontinence as a side effect of prostate cancer treatment or other condition often restrict social activities due to embarrassment from urine leakage. The good news is that there are effective treatment options for incontinence. Men dealing with incontinence need not feel alone and isolated, embarrassed or hopeless. Temporary and permanent treatment options for incontinence exist.
Tools for managing urine leakage
Common incontinence treatment solutions used by men suffering from bladder leakage include fluid restriction and planned restroom breaks. Men will often use various incontinence supplies such as adult diapers, pads or specially designed incontinence underwear. Adult diapers are often associated with groin/genital rash from constant skin exposure to urine-soaked pads. Penile clamps and catheters are another type of incontinence solution. Penile clamps stop the unwanted flow of urine out of the penis by applying constant pressure on the penis. They are often uncomfortable and may cause skin erosion and irritation. Condom catheters are placed on the penis and a tube from the end of the condom allows urine to flow out of the penis and into a drainage collection bag. Condom catheters are sometimes difficult to use as they need the condom to maintain its position over the penis to prevent subsequent urine leakage.
Drugs and/or exercises as treatments for male incontinence
There are currently no FDA-approved medications to treat male SUI because medications have not been found to be effective. However, some patients with stress urinary incontinence may also have overactive bladder (OAB) and may see improvement in their incontinence with OAB medications.
Various interventions used to treat male SUI include pelvic floor physical therapy with biofeedback and Kegel exercises. These incontinence treatments can improve SUI but rarely lead to a cure of the condition.
Male sling and artificial urinary sphincter – two surgical incontinence treatment solutions
Surgical solutions to treat male SUI are often recommended for my patients who fail or are not satisfied with nonsurgical treatment options or for those men who have moderate to severe bladder leakage. Common surgical procedures to treat SUI are the male sling and the artificial urinary sphincter (AUS).
(left image) The AdVanceTM XP Male Sling by Boston Scientific.
(right image) The AMS 800TM Urinary Control System, also called an artificial urinary sphincter (AUS).
The artificial urinary sphincter can treat all degrees of SUI25 and in my opinion is the most successful treatment for moderate to severe stress urinary incontinence.
The male sling was developed to treat incontinence. It is designed to treat male SUI after radical prostatectomy and has high patient satisfaction rates in appropriately selected patients. This minimally invasive procedure is most effective for men with mild or moderate SUI. Bladder leakage following prostate cancer surgery may occur because the cancer procedure can cause the urethra to prolapse or change in position. This change can prevent the external sphincter muscle from working as normal. The male sling is designed to support and reposition the urethra for better urine control. A soft mesh material is used as the sling and it is completely concealed within the body. Implanting the male sling is a minimally invasive procedure and is usually performed on an outpatient basis. Patient recovery is quick with most patients resuming normal activities within a few weeks. Patients treated with a sling typically experience continence or an improvement in their condition immediately. However, patients need to refrain from heavy physical activity or squatting for a few weeks after the surgery to avoid slippage of the sling.
The artificial urinary sphincter (AUS) is considered the gold standard for treatment of male SUI. The artificial urinary sphincter can treat all degrees of SUI25 and in my opinion is the most successful treatment for moderate to severe stress urinary incontinence. The AUS is designed to function like the man’s own external sphincter muscle to control urine. The AUS is made of three small components that are completely concealed within the body: a cuff placed around the urethra, a control pump and a pressure regulating balloon. The small balloon is placed in a cavity in the lower abdomen. The control pump is placed just beneath the scrotal skin. When the patient needs to urinate, he squeezes the pump which allows the fluid in the cuff closing off the urethra to return to the pressure regulating balloon. With the device fluid in the balloon, the cuff opens allowing urine to pass through the urethra. The cuff refills with fluid automatically and closes off the urethra again, shortly after the patient has urinated. Following AUS surgery patients remain incontinent until the artificial urinary sphincter device is activated, approximately 4-6 weeks after surgery.
The majority of my patients have achieved significant improvement in SUI and many will remain completely dry without the need for adult diapers or pads.
After male sling or AUS surgery, the majority of my patients have achieved significant improvement in SUI and many will remain completely dry without the need for adult diapers or pads. These procedures have enabled many men to resume normal social and life activities without worry or the embarrassment of urine leakage.
This physician is a Boston Scientific consultant but was not compensated for the creation of this article.