Incontinence

Male Stress Urinary Incontinence

This type of incontinence in men is seen mostly after previous prostate surgery and particularly after radical prostatectomy for cancer.
In some men this urinary leakage can be temporary after their surgery. However,stress urinary incontinence will remain permanently in many men and vary in degree from minor to total incontinence. Not only is this embarrassing for men and their wives but it can be costly.

Treatment Options for Stress Urinary Incontinence

1. protective garments and external penile clamps
2. kegels exercises or biofeedback
3. oral medications such as sudafed and tofranil
4. endoscopically delivered bulking agents such as collagen
5. surgical tapes and devices such as the Advance Male Sling or the artificial sphincter

For those men whose stress urinary incontinence has not resolved with time or where non surgical options have not provided satisfactory resolution of their urinary leakage then the outpatient Advance male sling is a very good option. Particularly,in those men with mild to moderate incontinence and want a permanent solution,this surgical procedure is very effective.

Men can be evaluated with an ultrasound study of their kidneys and bladder,a urinalysis,cystoscopy and often,a urodynamic study. If the investigative findings corroborate the patient’s symptoms and signs,then he may be a suitable candidate for this minimally invasive outpatient surgery. Under a short outpatient general anesthetic,the mans legs are elevated and placed in leg holders. A small incision is made between the scrotum and the anus and the bulbospongiosus muscle is dissected from the corpus spongiosum.

Transobturator needles are then used to puncture each groin and pass through the obturator fossa of the pelvic bones on each side to the perineal wound. The synthetic mesh sling is secured to the corpus spongiosum (which surrounds the bulbous urethra) and the arms of this sling are then picked up be the transobturator needles now poking into the perineal wound and the process of rotating these needles back into each groin places tension on the tapes and compresses the bulbous urethra to restore normal bladder control. Redundant tape is excised and the wound is closed in layers over this mesh sling. A Foley catheter is not used and most properly selected patients are continent immediately following the procedure and may resume non strenuous activities. Squats and strenuous activities should be curtailed for at least 6 weeks.

There are very few side effects to this procedure. There may be some temporary perineal discomfort and bruising. Infections are rare.

Men may experience stress urinary incontinence after prostate surgery. After the appropriate evaluations,it too may be treated with medications, Kegel exercises, endoscopic collagen or surgery as in placement of an incontinence sphincter or as in the placement of a sling such as the Ad-Vance sling procedure.