Male Urinary Incontinence

After radical prostatectomy (RP) surgery, most men will resolve their incontinence or urinary leakage problem at some point within the first year after surgery. However, some men will continue to require pads for protection and may need to consider other options.

Artificial Sphincter

Since 1972, we have had the option of using an artificial urinary sphincter in men whose post-RP incontinence is moderate to severe. The artificial sphincter is a fluid filled, surgically implanted device which places pressure around the urethra until the patient is ready to void; at that time, the patient squeezes a bulb in his scrotum to draw the fluid out of the device to allow urine to flow through the urethra. The device then slowly fills up with fluid again over several minutes.

Although the artificial sphincter remains the gold standard for the surgical treatment of post-RP incontinence, it does have some drawbacks. For one thing, it is a mechanical device which requires the patient to actively participate in scrotal pumping every time he wishes to void. For another, the patient must have the manual dexterity and mental capacity to do this.

InVance Male Sling

We now have another more conservative option for treating mild, moderate, and sometimes severe post-RP incontinence: the InVance Male Urethral Sling.

A significant benefit of the Invance Sling is that there are no working parts that the patient has to manipulate in order to urinate. It involves placing a mesh material between the pubic bones, tied in place using sutures attached to bone anchors placed on each side, putting pressure on the urethra. The sling can usually be put in during an outpatient procedure, and the catheter that is inserted during surgery is typically removed after 24 hours at home.

At Urology Centers of Alabama, after making some modifications in our technique, we have been able to achieve improvement of leakage in most patients using the InVance Sling alone. I have observed improvement even in heavy leakers.

In patients with both erectile dysfunction and stress incontinence, we now prefer to treat the leakage first and return at a later time to place a penile prosthesis if needed.

AdVance Male Sling

Finally, there is a newer device called the AdVance Male Sling, which is placed into position without the bone anchors. Rather than applying direct pressure to the urethra as in the InVance Sling, this sling actually alters the position of the urethra during straining or physical activity to prevent leakage. It is an exciting addition to our options for treating male incontinence, but it appears to be most helpful for patients with mild to moderate leakage.

The AdVance Sling, like the InVance Sling, requires no patient manipulation and, in most cases, can be done on an outpatient basis. Placement of either sling does not prevent future placement of an artificial sphincter if needed.

Although not every patient is a candidate for the above slings, the availability of these more conservative treatment options for post-RP incontinence has created a high degree of interest and hope in this patient population.

Kegel Exercises

1. Once you start urinating, try to stop or slow the urine without tensing the muscles of your legs, buttocks, or abdomen. This is very important. Using other muscles will defeat the purpose.
2. When you are able to stop or slow the stream of urine, you know that you have located the correct muscles. Feel the sensation of the muscles puling inward and upward.

TIPS:

1. You may squeeze the area of the rectum to tighten the anus as if trying not to pass gas. This helps locate the correct muscles.
2. Remember NOT to tense the abdominal, buttock, or thigh muscles.

Now you are ready to start these exercises:

1. After you have located the correct muscles, set aside time each day for three exercise sessions (morning, midday ,evening). It is important to do these exercises in different positions (laying, sittings, standing)
2. Squeeze your muscles to the slow count of five. Then, relax the muscle completely to the slow count of five. The five second contraction and five second relaxation make one “set”.You should try to complete 20-30 “sets” with each session.

TIPS :

When your pelvic floor muscles are very weak, you should begin by contracting the muscles for only two to three seconds. Begin doing these on a regular basis. In a few weeks, you should be able to increase the amount of time you are able to hold the contraction and the number of exercise sets you are able to do. Your goal is to hold each set for five seconds, relax for five seconds and to complete 20 - 30 in each of the three exercise sessions per day.

In the beginning, check yourself by looking in the mirror and placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh or buttock muscles move.If there is movement, continue to experiment until you have found the muscles for the pelvic floor only.

If you are unsure that you are contracting the correct muscles, at your next visit ask your physician or his nurse to help you identify the proper muscle contraction.

Your bladder control should begin to improve in three to four weeks. If you keep a record of your urine leakage each day, you should begin to notice fewer instances.

Pelvic muscle exercises also improve orgasmic function. Whether you are doing pelvic muscle exercise to improve or maintain bladder control or control orgasmic function,or both, they must be done on a regular basis.

Use daily activities such as eating meals, watching television and walking as times to do a few pelvic muscle exercises.