Surgical treatment options for male incontinence and their recovery processes

Incontinence, also known as bladder leakage, is a life-altering condition. Surgery to treat incontinence may likewise be life-changing. Before you decide to pursue incontinence surgery for male stress urinary incontinence (SUI), it's important to understand the treatment options and products available, the procedure recovery process, and what it may be like to live with an implant like a male sling or artificial urinary sphincter (AUS) device.

First, you should meet with a urologist for a focused physical exam and to have a discussion about your treatment goals. Depending on the severity of your incontinence and your medical history (for example, if you received radiation therapy to treat prostate cancer), one or more implantable device(s) may be indicated for your SUI procedure.

For less severe cases of SUI (e.g., cases with symptoms like occasional leakage when coughing, sneezing, or lifting heavy objects; and cases that only use one to two pads a day), a urethral sling may be surgically implanted to help treat incontinence. The male sling is designed to work like a hammock to support the urethra, helping to provide bladder control for men. The urethra is the tube from the bladder that carries urine out of the body. Slings may provide passive relief from incontinence.

For moderate to severe cases of SUI, the gold standard of surgical treatment is the artificial urinary sphincter (AUS). It involves the implantation of a cuff around the urethra that replicates the closure mechanism of those muscles. It is operated with a pump that is placed in the scrotum. A balloon roughly the size of a marble is connected to the cuff and the pump with tubes. When a patient uses the pump, the fluid in the cuff constricting the flow of urine is moved to the balloon and the cuff opens, allowing for urination. The cuff reactivates itself automatically within one to two minutes, stopping urine from leaving the body. The artificial urinary sphincter technology has been available for over 50 years, and in a survey of 278 male patients, more than 90% of them reported that they would have this surgery again.¹

After sling implant surgery, patients may be continent immediately following the procedure. Hypercontinence, or the inability to urinate, may occur immediately following the procedure and should be discussed with your physician. Treatment consists of either a short-term catheter or self-catheterization. The sling procedure is performed in an outpatient setting and is designed to allow most patients to return to normal, daily activities 1-2 weeks after the procedure. However, this is up to your doctor's discretion.

In the case of the artificial urinary sphincter (AUS) implantation, a six-week healing period should be observed after the incontinence surgery, as this allows the cuff to heal around the urethra. During this healing period, the leakage of urine may continue as the device treating the incontinence isn’t yet activated. The AMS 800™ Artificial Urinary Sphincter procedure can be performed on an outpatient basis or may require a short hospital stay. A catheter, which is a tube placed in the bladder to drain urine, may be used at the discretion of your urologist.

Sling patients are advised to avoid squatting movements for several weeks to allow for the sling to heal with sufficient compression of the urethra.

Patients with an artificial urinary sphincter need to let the device, specifically the cuff, heal around the urethra before it it can be activated by a physician. This period is usually six weeks, and incontinence may persist during this time. Patients return to their doctor's office approximately six weeks after the surgery to have the device activated and learn how to use it. The AMS 800™ Artificial Urinary Sphincter gives most men the ability to achieve continence once activated. Long-term studies reported that patients may use 1 pad or less per day following their procedure.^2-4

The male urethral sling is a passive device and requires no manipulation on the patient's part. The sling acts as a “hammock,” repositioning and supporting the urethra, and is designed to to help restore normal bladder control. When a patient needs to go to the bathroom, the closure muscle relaxes. His bladder during voiding provides increased pressure. Slings may lose some of their effectiveness over time, which may be due to decreased tissue tension and decrease of muscle mass during normal aging. If incontinence returns to a bothersome level, the sling procedure can be repeated or the patient may be a candidate for an artificial urinary sphincter.

The artificial urinary sphincter is an active device, and it is designed to mimic the function of the muscular closure. An extent of manual dexterity is required to open the cuff to use the bathroom. This is done by a single squeeze of the pump, which is placed in the side of the scrotum. It is easily accessible in a standing position. The cuff of the AUS is designed to close automatically after a period of one to two minutes.