Urinary incontinence has many forms, including three main types:
- stress urinary incontinence — due to leakage from activities such as lifting objects, climbing stairs, or strenuous activity
- urge urinary incontinence — associated with leakage associated with the sensation or urge to urinate
- mixed urinary incontinence — Combining stress and urge incontinence
Stress urinary incontinence can be a side effect of prostate cancer surgery and can negatively affect the patient’s quality of life. Up to 10% of men may experience some degree of stress urinary incontinence after surgery.
male stress urinary incontinence
Stress urinary incontinence in men after prostate surgery is due to multiple factors related to the patient’s anatomy, prostate cancer, and the surgery performed. Ultimately, this leads to weakened sphincter muscles and a relaxed pelvic floor. The sphincters control the release of urine, and the urethra is the small tube that empties the bladder. A prostatectomy removes some of the control provided by the prostate and bladder, leaving the patient solely dependent on the external sphincter muscle.
Normally, the sphincter remains closed as the bladder fills with urine until you reach the toilet. Weakened muscles and a relaxed pelvic floor have trouble retaining urine, so any movement that puts force on the abdominal and pelvic muscles can put pressure on the bladder and cause it to leak. , bending over, lifting things, and even laughing.
Symptoms of stress urinary incontinence that begin after prostate surgery may resolve spontaneously with time and pelvic physical therapy. Patients typically show continuous improvement for 12 months after surgery and can try non-surgical treatments such as physical therapy before considering surgical treatment options such as male urethral slings and artificial urethral sphincters. can.
urethral sling for men
The male urethral sling is suitable for men with mild to moderate stress urinary incontinence (defined as using 1 to 4 pads per day). The surgeon creates a sling or hammock using a synthetic mesh material to support and hold the urethra and pelvic floor back in place. Some slings also provide sphincter compression support.
A cystoscopy will be required before surgery to ensure that the sphincters are working.
Male urethral slings are performed on an outpatient basis and the patient can be discharged on the same day. Heavy labor and strenuous exercise are restricted for about 6 weeks. Care should be taken when climbing ladders or squatting for about 3 months after surgery, as excessive hip flexion may loosen the sling.
Approximately 80% of men using male urethral slings improved after surgery and the majority no longer needed pads after surgery.
artificial urethral sphincter
This surgical procedure is more invasive than the male urethral sling and is suitable for men with severe stress urinary incontinence, defined as using four or more pads per day. It is also suitable for patients with sphincter damage due to radiotherapy or failure of male urethral slings.
There are multiple components to the placement of the artificial urethral sphincter. A small cuff is placed around the urethra. It replaces the function of the sphincter muscle. A tube connects the cuff to a pressure-regulating balloon placed in the lower pelvis and a pump in the scrotum. A pump is manually operated to open the urethral cuff and drain urine out of the body.
Some patients can go home the same day as surgery, while others need an overnight hospital stay to recover.
After surgery, the artificial urethral sphincter is inactive for about a month while the body heals. Heavy lifting and exercise are restricted during this time. Patients return to the clinic and are instructed in proper use of the device. With proper training and consistent use, the artificial urethral sphincter is effective in treating symptoms of severe stress urinary incontinence in men.
Talk to your health care team if you have symptoms of urinary incontinence or are concerned about your prostate or urinary health.
David Yang, MDis a urologist in Mankato, Minnesota.