Male Urinary Incontinence
Dr Köhler sees men with all forms of incontinence. Untreated, incontinence leaves men afraid to leave the house due to fear of accidents or the odor of urine. In the case of stress incontinence, very effective treatments are available that allow men to resume normal life activities without the fear of embarrassment. After prostate surgery, sometimes devices for both stress incontinence and erectile dysfunction are necessary and can both be placed with a single surgery.
What is urinary incontinence?
Over 2 million men suffer with incontinence. It is a serious problem that men are reluctant to discuss with others. When the muscle (sphincter) that holds the bladder neck closed is not strong enough to retain urine in the bladder, the result is urinary incontinence. Incontinence may occur when:
- The sphincter is too weak
- The bladder muscles contract strongly
- The bladder is not emptied regularly
In men, urinary incontinence often is related to a medical problem or a treatment involving:
- The prostate gland
- Enlargement (benign prostatic hyperplasia, BPH)
- Prostate removal due to cancer
What are the types of incontinence?
Stress Incontinence: Is the accidental release of urine when pressure is applied to the bladder, such as when you cough, sneeze, laugh or lift something heavy. This is the most common type of incontinence post-prostate cancer.
Urge Incontinence: Is when the bladder contracts at the wrong time giving you the feeling that you have to urinate immediately even if you may have just emptied your bladder.
Overflow Incontinence: Is characterized by leaking when the bladder does not empty properly. This can be due to other medical conditions such as an enlarged prostate or a narrowing of the urethra.
Total Incontinence: Is continual leakage of urine due to complete sphincter deficiency
How is incontinence treated?
Proper treatment can help you return to a more natural lifestyle.
- Regain dignity
- Resume intimacy
- Save money on protective garments
The type of incontinence that you are diagnosed with will determine your treatment options. Some options available are:
- Behavioral modification
We will focus on the permanent surgical treatment available for stress incontinence and incontinence as a result of prostate removal.
Once an accurate diagnosis is made by your urologist, it may be determined that the best way to treat your incontinence is to have a bulbourethral sling/male sling implanted.
The sling is made of a polypropylene mesh material, which is implanted underneath the bulbous urethra to elevate and apply a gentle compression to prevent urine leakage.
Typically, the male sling is inserted during an out-patient procedure. Individual recovery time may vary, but the average time is 4-6 weeks. During this time, heavy lifting should be avoided. Your physician will discuss your recovery plan in greater detail.
The male sling is a permanent solution. Once the sling is in place, you can enjoy the active lifestyle you had before, playing sports, dancing and just carrying in the groceries without fear of leaking.
Following the placement of a male sling, it is important to follow the instructions provided by your physician and on the document below to ensure the best outcomes. If you have any questions on the post procedure instructions, please contact your physician for clarification.
Another treatment option is the Artificial Urinary Sphincter (AUS). 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 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 long term 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.
The link between incontinence and erectile function
- Prostate Cancer does not create the problem; the treatments do. Many men who suffer from incontinence also have Erectile Dysfunction (ED).
- Treatment options may affect continence and erections by impacting the nerves or blood flow. Such as:
Prostatectomy – radical, robotic, or nerve sparing: During the procedure the nerve bundles or blood vessels may be damaged, affecting continence and/or erectile function.
- Radiation therapy: Over time, radiation therapy may damage blood vessels to the penis, preventing blood flow and affecting erectile function.
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