Urinary incontinence is a surprisingly common problem. It is thought to affect millions of people, and can be a source of embarrassment or distress. Men may experience involuntary leakage for a number of reasons, including as a result of prostate surgery. But what treatments are available for this problem?
What are the solutions for male urinary incontinence?
For mild or moderate leakage, the solution is a sling or mesh implant underneath the urethra, which pushes it back to its original position. In more severe cases, when several hundred millilitres of urine can be accidentally lost per day, the most effective solution is the implantation of a prosthesis – an artificial urinary sphincter, which achieves very satisfactory results. After this surgery, the patient only has to "activate" the sphincter every time he wants to urinate.
What is a “sling” or “mesh implant” and how does it work?
There are several types of mesh implants, or slings. They are made of a synthetic mesh material, and are positioned below the urethra to push it back into position and prevent urinary leakage. To hold them in place, they may be attached to the pubic bone, or to the fibrous tissue of the rectum, in the case of the bulbourethral sling, which is similar to mesh implants used for incontinence in women.
When is a “sling” or “mesh implant” recommended?
When a patient has their prostate removed to treat cancer, the position of the bladder and urethra changes, causing urinary leakage. It is necessary to wait for between 6 months and one year after radical prostate surgery to see if the patient gradually regains continence naturally with physiotherapy of the pelvic floor. If you are still suffering from urinary incontinence after one year, then we resort to a mesh that moves the urethra and the neck of the bladder back to its original position if leakage is mild or moderate, or to an artificial urinary sphincter if the leakage is more severe.
In your experience, how do patients with urinary incontinence feel about an artificial urinary sphincter and mesh implants?
The patient gains control over the artificial urinary sphincter after 30 days and published data indicates that 92% of men with an artificial urinary sphincter are satisfied and 96% would recommend it to another patient with urinary incontinence. As regards successful mesh implants, more than 90% of the patients are satisfied with the surgery.
Are the effects of these treatments long-lasting?
In principle, they are long-term, durable solutions, although in the case of the artificial urinary sphincter, with it being a mechanical device, it may require check-ups or the replacement of specific components over time. This is not a problem, because it can be made to work again with a small surgical procedure. The artificial urinary sphincter is the most effective and recommended solution for severe urinary incontinence in men.