Surgical Procedures for Male Stress Incontinence
Although the technique was originally developed in the early 1970’s, the male sling procedure has not always been a reliable option for the treatment of stress incontinence. Fortunately, the recent development and use of newer materials and better surgical fixation methods has improved the surgical outcome for men with stress incontinence.
The male sling procedure essentially uses a mesh material to compress the urethra and provide bladder outlet resistance. This additional resistance can prevent the leakage of urine when abdominal pressures rise, such as with coughing, sneezing, laughing, or lifting.
Studies have revealed and our own experience indicates that this sling is best used for men who have milder degrees of stress incontinence. This is because when men have severe incontinence, the urethra cannot be compressed sufficiently to control urinary loss. For more severe incontinence, the artificial urinary sphincter is required.
The urinary sphincter, which is located in the area where the urethra meets the bladder, is the circular muscle enveloping your urethra. Normally, your sphincter remains closed when you want to hold your urine, and it opens when you want to use the toilet. When the urinary sphincter does not close properly, urine may leak quite freely during activity and at rest. Male patients who have undergone radical prostatectomy, transurethral resection of the prostate (TURP), pelvic trauma, or pelvic radiation are particularly susceptible to this type of leakage. Neurologic disorders can also render the sphincter less able to close tightly.
Fortunately, the artificial urinary sphincter can reduce or eliminate leakage for many male patients with this type of leakage. The AUS works by using a small, water-filled cuff to compress the urethra, holding urine inside the bladder until the patient is ready to urinate. Before urination the patient simply depresses a button in the scrotal sac causing the small cuff to open, and urine flows out through the urethra. The cuff then re-inflates on its own, assuring that the urethra is compressed and the patient stays dry.
Here at the University of Chicago, Dr. Gregory Bales has successfully placed more than 100 sphincters. In the general operating room, each patient first receives an anesthetic, either general or spinal. The surgical procedure takes about 90 minutes, and requires an overnight hospital stay so that the patient may receive intravenous antibiotics. Patients do not need a catheter, and they should refrain from exertional activity for about one month. The artificial sphincter cuff will be not be inflated immediately after surgery to allow the tissues to heal. About six weeks after surgery, the sphincter will be activated by Dr. Bales and the patient will be taught how to inflate and deflate the cuff.
Urologists and other surgical specialists have been creating male slings for many years with variable results. You may know someone who had a male sling surgery that just did not hold up over the years.
Importantly, new technological advances have allowed surgeons to give patients a more durable solution. Both polypropylene and Teflon® meshes can now be used to strengthen and help assure the long-term success of these types of repairs. Such mesh materials are designed specifically for pelvic surgeries and have properties that prevent them from becoming infected.