Till date, no
effective treatment is reported for post-prostatectomy urine incontinence in
and similar periurethral bulking agents have been used widely for incontinence
but due to migration and absorption of these agents, their use is restricted.
These injections are
more effective in women than in men.
In females, a
medication called duloxetine is known to increase resting urethral pressure and
subsequently decreases urine incontinence.
The first line of
treatment for early incontinence experienced in first 6-12 months post
prostatectomy is pelvic floor muscle exercise and non-invasive therapies.
lifestyle and pharmacotherapy are also effective controlling urine
incontinence. However in 10 percent patient, incontinence is reported for more
than a year postoperatively. In such patients, surgery is advised.
In 1973, the first
artificial urinary sphincter was invented. Depending upon the requirements,
researches have been going on to develop better implants. The old AUS 800 are
now outdated but still widely used. Recently discovered devices are developed
to overcome the disadvantages of AUS 800.
These new devices are
potential tools for management of urine incontinence in men.
Recently four devices
have been developed that are devoid of disadvantages associated with the
The FlowSecure TM
(RBM-Med) is a newly developed prosthesis for the incontinence management.
Professor Cragg and Professor Mundy A. R. at the London's Institute of Urology
and Nephrology in 2006 developed this device.
It is adjustable
device filled with saline without contrast, therefore can be monitored by
The precise location
of the device and the integrity of device's components can be evaluated by MRI.
Knight and colleagues
have reported the effectiveness of FlowSecure in 9 male patients aged between
60-66 years. They were followed for twelve months and they recuperated quite
well after surgery.
Constrictor (PUC) was formulated primarily for pediatric patients with
deficient bladder sphincter function. It was designed by Dr. Fabio Vilar in the
Constrictor consists of a constrictor cuff linked by a silicone tube to a
valve. The cuff is placed around the bladder neck or the urethra. The pressure
in the cuff is controlled by fluid injected through the valve. Simone et al
conducted a study on 43 patients with mild urinary incontinence. PUC was
implanted following prostatectomy. Amazing results were reported with success
rates being 86% and complications such as hematoma, erosion, malfunctioning and
infection were noticed in 6 patients. Studies by Lima et al did not produce so
More research is
required to establish the efficacy and safety of the device. Low cost and
simplicity are the factors in support of PUC implantation.
The ZSI 375 is an
artificial sphincter developed by ZEPHYR Surgical Implants, a Swiss-French
Company. Dr. Christophe Gomez-Llorens and Raphael Gomez-Llorens in 2005
invented this device. ZSI 375 is used exclusively in men and treats severe
The Tape Mechanical
Occlusive Device (GT Urological, Minneapolis, MN) is another useful artificial
sphincter device. It applies circumferential pressure on urethral sphincter and
is easy to use.
This device has an
on/off button that makes it extremely easy to use. So far it has been tried and
tested in canines and clinical trials in humans are still to follow.
New Artificial Urinary Sphincter Devices in the
Treatment of Male Iatrogenic Incontinence; Ioannis et al; Advances in Urology;
Volume 2012 (2012), Article ID 439372