When people think of incontinence, most of us think of females that deal with some leakage with coughing, sneezing or laughing as they get older. There are great treatments for female incontinence, and women tend to talk to their doctors and friends about it. Men, however, don’t tend to share this important part of their quality of life with those around them.
Incontinence in men, just like in women has two primary types. Urgency incontinence, which is leakage when you can’t make it to the bathroom in time, and stress incontinence which is usually associated with prostate cancer surgery.
Urge incontinence in men, is evaluated and treated much like urgency incontinence in women. Physical therapy, medications and sometimes higher level treatments such as bladder botox injections or Interstim are recommended.
Male Stress Incontinence Treatment After Prostate Cancer Surgery
In most men who have prostate cancer surgery, their incontinence will resolve. For some, this takes only 6 weeks, for others it can take up to a year or more. The general rule after prostate cancer surgery is for conservative evaluation, encouragement and physical therapy. Physical therapy is critical to restoring the strength of the pelvic floor and regaining function. If incontinence persists after a year despite physical therapy, and is bothersome, then other options can be considered.
In general, there are 3 treatments for male stress incontinence. Injection of urethral bulking agents, the “Male Sling”, and the Artifical Urinary Sphincter (AUS).
- Bulking agents come in a variety of types, and have the advantage of being minimally invasive, but unfortunately they don’t work very well, and require repeat treatments. They also can cause scarring and the loss of elasticity of the urethra which can make other treatments less successful. The use of bulking agents, therefore is not favored except in certain circumstances that can be discussed with your doctor.
- The male sling has been on the market since 2006. There are two brands, the Advance Male Sling, and the Virtue Male Sling. Both have been used successfully. In patients who have mild to moderate incontinence the male sling has several advantages. Dr. Neeb was the first urologist in Central Oregon to place the Advance Male Sling in 2007.
- Unlike the AUS, once it is in place, it does not require manipulation to open and close the urethra.
- It starts to work on the same day that it is placed. There is no waiting period like in the AUS
- It has no mechanical parts, so there is nothing to wear out or break
- If the male sling doesn’t work, an artificial urinary sphincter can still be placed (it does not limit treatment options)
- The Artifical Urinary Sphincter is a mechanical cuff that is placed around the urethra. There is a pump in the scrotum that manipulated to open the urethra whenever the need to urinate occurs. It has several advantages too, including its successful track record as a reliable device. The use of artificial sphincters are limited to certain situations and include:
- Severe incontinence that will not likely be improved by a male sling (5 + pads per day, or leaking at night while lying down)
- A patient that has undergone radiation or previous urethral surgery, where a male sling won’t be as effective
- Patient preference
Scheduling Male Incontinence Treatment
For male stress incontinence, there are many options. It is often amazing how long it takes patients to seek care for these issues. Please request a copy of the book, “Ending ED and Incontinence” for a more detailed discussion of treatment options, or contact Urology Specialists of Oregon at (541) 322-5753 to make an appointment today.