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Artificial urinary sphincter


Photo courtesy of Boston Scientific

Prostate cancer and urinary incontinence

Each year, more than 1.1 million men worldwide are diagnosed with prostate cancer. It is the second most diagnosed cancer in men worldwide. If detected early, prostate cancer is usually curable. Like many men, you have probably had surgery to treat your prostate cancer.

Advances in surgical techniques (robot, focal therapy) have allowed an increasing number of patients to operate successfully, and surgery offers a very high probability of curing localized prostate cancer. However, and although it is not frequent, complications such as urinary incontinence can sometimes appear. One of the options to solve it is the placement of an artificial urinary sphincter.

On this page we will offer you information about what you can expect from surgery to correct incontinence by placing an artificial urinary sphincter.

** In the following pdf document you can find a brochure with very practical information for patients undergoing radical prostatectomy and suffering from incontinence or erectile dysfunction problems.

 (“Life after prostate cancer). 

Why does incontinence appear after prostate cancer surgery?

When the cancer is removed, the nerves or muscles in your body that help you control the flow of urine and allow you to get an erection may have been damaged.

Although patients often experience urine leakage immediately after surgery,

The losses usually disappear after several weeks or months.

If incontinence persists between six and twelve months, you should consult a urologist as there are different options to solve it.

And the same goes for erectile dysfunction (ED). Erectile dysfunction is a known potential complication of prostate cancer treatment. With the advent of nerve-sparing interventions, some men are able to regain their erectile function. Since every man has a different experience, some may not regain their ability to achieve natural erections.

The good news is that there are several treatment options for incontinence and erectile dysfunction.

You should not resign yourself to living with incontinence after having surgery for prostate cancer. Dr Puche can inform you of all the available options and choose between them the one that best suits your needs.

What non-surgical options do I have to regain my continence?

a.- Diapers, pads, pads, special underwear: Initially and for incontinence that does not persist over time. They provide temporary help until you regain urinary control.

b.- Regular pelvic floor or Kegel exercises:

These exercises isolate and strengthen the pelvic floor muscles and can help you regain bladder control after prostate surgery. It is important that these exercises are performed correctly and regularly. Practicing the exercises with a physical therapist nurse can be helpful to make sure you are doing them well and often enough.

I propose the following explanatory video to learn how to perform these exercises correctly.

What surgical options do I have to regain my continence?

When the previous options fail and there is no improvement in continence within a period of 6-12 months, we can resort to corrective surgery. There are basically two approaches:

1.- Male band or sling, what is it and how does it work?: 

The male suburethral band system is placed on the body through a minimally invasive surgical procedure to correct stress urinary incontinence. Through three small incisions, a small “band” of synthetic mesh is introduced into the body. The band supports the urethra and restores normal bladder control. Almost all patients regain continence immediately after the intervention. It is a “simpler” surgery than artificial urinary sphincter surgery but it is not suitable for all types of incontinence.

In this clip you can see schematically how a band or sling is placed for male incontinence:

2.- Artificial urinary sphincter, what is it and how does it work?:  

The placement of an artificial urinary sphincter is the “gold standard” of treatments to combat incontinence. Basically it is an implantable device, which imitates the function of a healthy urinary sphincter, closing the urethra to stop the flow of urine.

The intervention consists of implanting an inflatable cuff around the urethra, which is inflated by means of a balloon filled with fluid, placed behind the iliac bone. Using a pump inserted into the scrotum, the patient deflates the cuff when he needs to urinate. It will automatically re-inflate, firmly closing the urethra and preventing leaks.

At first glance it seems like a complex mechanism, but in the following video you can easily see how an artificial urinary sphincter works.

Advantages of the artificial urinary sphincter:

The artificial urinary sphincter is not a new or recently applied technique. Its use accumulates extensive experience and demonstrated results:

    • More than 40 years of clinical use of the artificial urinary sphincter with more than 180,000 devices implanted worldwide.
    • Continence rate of 90% in one of the most representative studies in 435 patients with a mean follow-up of 68 months (Raj GV, Peterson AC, Toh KL, Webster GD. Outcomes following reviews and secondary implantation of the artificial urinary sphincter. J Urol. 2005 Apr; 173(4):1242-5).
    • The device is covered by a coating with surface antibiotic treatment (InhibiZone) designed to reduce infections.
    • Restores the normal functioning of the sphincter, opening and closing the urethra at the patient’s will.
    • High degree of satisfaction among patients: Up to 96% of patients who have had an artificial urinary sphincter placed would recommend the intervention to a friend (Montague DK. Artificial urinary sphincter: long-term results and patient satisfaction. Adv Urol. 2012; 2012 :835290).

Surgery for male urinary incontinence after prostate cancer treatment is not free of complications. Device infection or persistent incontinence are possible and each patient presents unique and special clinical conditions. It is very important that your urologist is an expert in the placement of these devices. Dr Puche is currently coordinator of the Reconstructive Urology Unit of the University Hospital Virgen de las Nieves de Granada and houses extensive experience in the placement of this type of devices.

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