A New Treatment for Male Stress Incontinence

  • When people talk about incontinence, they are often referring to the problems women face. And although it can be very embarrassing and difficult to have incontinence as a woman, it is often accepted and considered "a part of aging." I do not believe this to be true, but because incontinence in women is fairly common, it doesn't have the same stigma it may have for men. Again, let me emphasize that I believe incontinence in women is a problem, but today I want to focus a little bit on male incontinence.


    Stress Incontinence After Prostate Surgery


    In general, stress incontinence is an acquired form of incontinence after having prostate surgery, most commonly prostate removal for cancer. The amount of incontinence a man may have after surgery is fairly unpredictable and quite variable person to person. Over the years, many forms of surgical treatments have arisen, but recently I have embraced the newest type, and find it to work quite well, and I wanted to share my positive experience.

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    In general for men, there are three types of surgical correction. The easiest and least invasive option involves injecting collagen or its synthetic equivalent into the tissues in the urethra near the opening to the bladder. This helps create some resistance to pressure from the bladder. This option works best for men with minimal incontinence, but it often needs to be repeated because the body absorbs collagen over time.


    The most invasive option is placing an artificial urinary sphincter. This has many mechanical components and requires the activation of a pump and reservoir that is implanted, but you will be dry! This is for men with florid incontinence. In general, this option is used less and less because the middle option is usually good enough and has less complications and mechanical failures.


    The middle option has become the most common form of treatment that I use in my practice, and is a good fit for many of my patients. For many years, there was a male sling used that involved screwing mesh into the underside of the pelvis to push up against the urethra. This worked very well, but some men had chronic pain from the screws and let me tell you that you have to get the screws just right in order to be placed perfectly, and the procedure could become quite lengthy because of this. It was a good option, but I have seen the light, and have converted to the newest form of the male sling.


    Following suit with the minimally invasive type of slings that women have been able to enjoy recently, there is now the trans-obturator sling for men. The incision is similar to that for the older sling but the procedure involves only placing a mesh-like material against the urethra to increase resistance. The complication rate is pretty low, and the procedure itself is easier for the surgeon. The results are comparable or better to the older sling that used bone anchors.


    If you are a male with acquired stress incontinence, it is easier than ever to get a good surgical correction. I urge you to talk to your urologist about this procedure if it sounds like something that may be appropriate for you. Not everyone is a candidate for surgery, but it never hurts to ask!

Published On: August 29, 2007