Surgical Treatments of Male Stress Urinary Incontinence
Stress urinary 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 presented below:
Treatment 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 incontinence.
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.
The artificial 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 pages. doi:10.1155/2012/287489