incontinence i.e. involuntary leakage of urine on effort, exertion, sneezing or
coughing is a common problem affecting elderly men, especially those who have
undergone prostate treatments like surgery and radiation
. Artificial sphincters and surgeries are used in the treatment of
stress urinary incontinence. A review
article in Advances in Urology
journal recently updated the latest in the field, a brief summary of which is
options for male urinary stress incontinence include surgery or insertion of an
artificial urethral sphincter. These procedures should be done at least 6 to 12
months after the start of incontinence.
Male sling is
used in cases of low-to-moderate incontinence, where the patient needs 1 to 3
pads per day. Four types of male sling operations are
done, the bone-anchored slings (BAS), retrourethral transobturator sling (RTS),
the adjustable retropubic sling (ARS) and the quadratic sling. The slings bring about compression on the
urethra and sometimes increase the angulation of the urethra and thus prevent
The above procedures have had varying degrees of
success, as observed in different studies. Complications of the BAS procedure
include infection, erosion, de novo urgency/overactivity and pain. Complications of the RTS procedure include
temporary urinary retention, urethral injury, pain and need for sling
removal. Complications with the ARS
slings appear to be more common that with the BAS and RTS slings and include
infections, erosion, bladder perforation, urinary retention and pain. The quadratic sling is a recently introduced
sling with very limited data on its usefulness and complications.
urethral sphincter (AUS) is done in patients with large-volume incontinence. The device consists of a pump placed in the scrotum, pressurized
reservoir placed in the muscle of the abdomen, and a sphincter cuff placed
around the urethra. The fluid-filled
cuff surrounds the urethra and maintains pressure over it. When the patient has to void the bladder,
the pump pushes the fluid into the reservoir, thus reducing the pressure on the
urethra and permitting voiding of urine.
The success rate of AUS also varies in different
studies. Complications include urethral
atrophy resulting in recurrent incontinence, erosion, infection, and mechanical
failure of the device.
Ongoing research is likely to bring out even better
options for the treatment of male urinary stress incontinence to increase the
effectiveness and reduce complications of the current procedures.
1. Trost L and Elliott DS. Male
Stress Urinary Incontinence: A Review of Surgical Treatment Options and
Outcomes. Advances in Urology. Volume 2012, Article ID 287489, 13