Brett Mellinger, MD
Board-certified urologist with 30 years of experience
Stress urinary incontinence (SUI), or bladder leakage, occurs when the urinary sphincter muscle is weakened or damaged and fails to stop the flow of urine during physical activity or movement. Stress urinary incontinence urine leakage can occur with coughing, sneezing, or physical exertion. I see this condition most often after prostate cancer surgery, but this type of bladder leakage problem can develop after enlarged prostate surgery, radiation therapy for prostate cancer, pelvic trauma, or neurologic disorders. As many as 50% or more of men report leakage immediately after prostate cancer surgery.1 Most of the patients I see heal within the first few weeks to months. Nearly 1 in 10 of them still have daily bladder leakage more than a year after surgery.2 Patients who suffer from stress urinary incontinence as a side effect of prostate cancer treatment or other condition often restrict social activities due to embarrassment from urine leakage. The good news is that there are effective treatment options for incontinence. Men dealing with incontinence need not feel alone and isolated, embarrassed, or hopeless. Temporary and permanent treatment options for incontinence exist.
Tools for managing urine leakage
Common incontinence treatment solutions used by men suffering from bladder leakage include fluid restriction and planned restroom breaks. Men will often use various incontinence supplies such as adult diapers, pads, or specially designed incontinence underwear. Adult diapers are often associated with groin/genital rash from constant skin exposure to urine-soaked pads. Penile clamps and catheters are another type of incontinence solution. Penile clamps stop the unwanted flow of urine out of the penis by applying constant pressure on the penis. They are often uncomfortable and may cause skin erosion and irritation. Condom catheters are placed on the penis and a tube from the end of the condom allows urine to flow out of the penis and into a drainage collection bag. Condom catheters are sometimes difficult to use as they need the condom to maintain its position over the penis to prevent subsequent urine leakage.
Drugs and/or exercises as treatments for male incontinence
There are currently no FDA-approved medications to treat male SUI because medications have not been found to be effective. However, some patients with stress urinary incontinence may also have overactive bladder (OAB) and may see improvement in their incontinence with OAB medications.
Various interventions used to treat male SUI include pelvic floor physical therapy with biofeedback and Kegel exercises. These incontinence treatments can improve SUI but rarely lead to a cure of the condition.
Male sling and artificial urinary sphincter — two surgical incontinence treatment solutions
Surgical solutions to treat male SUI are often recommended for my patients who fail or are not satisfied with nonsurgical treatment options or for those men who have moderate to severe bladder leakage. Common surgical procedures to treat SUI are the male sling and the artificial urinary sphincter (AUS).
(left image) The AdVanceTM XP Male Sling by Boston Scientific.
(right image) The AMS 800TM Urinary Control System, also called an artificial urinary sphincter (AUS).
The artificial urinary sphincter can treat all degrees of SUI3 and, in my opinion, is the most successful treatment for moderate to severe stress urinary incontinence.
The male sling was developed to treat incontinence. It is designed to treat male SUI after radical prostatectomy and has high patient satisfaction rates in appropriately selected patients. This minimally invasive procedure is effective for men with mild or moderate SUI.4 Bladder leakage following prostate cancer surgery may occur because the cancer procedure can cause the urethra to prolapse or change in position. This change can prevent the external sphincter muscle from working as normal. The male sling is designed to support and reposition the urethra for better urine control.5 A soft mesh material is used as the sling, and it is completely concealed within the body.5 Implanting the male sling is a minimally invasive procedure and is usually performed on an outpatient basis. Patient recovery is quick with patients resuming normal activities within a few weeks. Patients treated with a sling typically experience continence or an improvement in their condition immediately.6 However, patients need to refrain from heavy physical activity or squatting for a few weeks after the surgery to avoid slippage of the sling.
The artificial urinary sphincter (AUS) is considered the gold standard for treatment of male SUI. The artificial urinary sphincter can treat all degrees of SUI3 and, in my opinion, is a successful treatment for moderate to severe stress urinary incontinence. The AUS is designed to function like the man’s own internal sphincter muscle to control urine.5 The AUS is made of three small components that are completely concealed within the body: a cuff placed around the urethra, a control pump, and a pressure regulating balloon.5 The small balloon is placed in a cavity in the lower abdomen.5 The control pump is placed just beneath the scrotal skin.5 When the patient needs to urinate, he squeezes the pump, which allows the fluid in the cuff closing off the urethra to return to the pressure regulating balloon.5 With the device fluid in the balloon, the cuff opens allowing urine to pass through the urethra.5 The cuff refills with fluid automatically and closes off the urethra again, shortly after the patient has urinated.5 Following AUS surgery patients remain incontinent until the artificial urinary sphincter device is activated, approximately 4–6 weeks after surgery.
A majority of my patients have achieved improvement in SUI and many will remain completely dry without the need for adult diapers or pads.
After male sling or AUS surgery, a majority of my patients have achieved improvement in SUI and many will remain completely dry without the need for adult diapers or pads. These procedures have enabled many men to resume normal social and life activities without worry or the embarrassment of urine leakage.
- Catslons WJ, Ramos CG, Carvalhal GF. Contemporary results of anatomic radical prostatectomy. CA Cancer J Clin. 1999 Sep-Oct; 49(5);282-96.
- Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012 Sep;62(3):405-17.
- Montague DK. Artificial urinary sphincter: long-term results and patient satisfaction. Adv Urol. 2012;2012:835290.
- EAU Guidelines on Urinary Incontinence in Adults. European Association of Urology. 2020.
- Data on file with Boston Scientific.
- Welk B, Herschorn, S. The male sling for post-prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes. BJU Int. 2012 Feb;109(3):328-44.
This physician is a Boston Scientific consultant but was not compensated for the creation of this article.
Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.
AdVanceTM XP Male Sling System
Your doctor is your best source for information on the risks and benefits of the AdVanceᵀᴹ XP Male Sling System. Talk to your doctor for a complete listing of risks, warnings and important safety information.
The AdVanceᵀᴹ XP Male Sling System is intended for the treatment of male stress urinary incontinence (SUI). Potential risks may include inability to urinate (urinary retention), return to incontinence, infection, erosion, and pain. MH-557011-AA
AMS 800TM Artificial Urinary Sphincter
Your doctor is your best source for information on the risks and benefits of the AMS 800ᵀᴹ Artificial Urinary Sphincter. Talk to your doctor for a complete listing of risks, warnings and important safety information.
The AMS 800ᵀᴹ Artificial Urinary Sphincter is intended for use in the treatment of male stress urinary incontinence (intrinsic sphincter deficiency) following prostate surgery.
Men with diabetes, spinal cord injuries or skin infections may have an increased risk of infection. Some AMS 800 devices contain an antibiotic (InhibiZoneᵀᴹ Antibiotic Surface Treatment). The device may not be suited for patients who are allergic to the antibiotics contained within the device (rifampin, minocycline or other tetracyclines) or have systemic lupus.
Potential risks may include: device malfunction/failure leading to additional surgery, wearing away/loss of tissue (device/tissue erosion), inability to urinate (urinary retention), infection, and pain/soreness. MH-545611-AB
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Boston Scientific (BSC) does not promote or encourage the use of its devices outside their approved labeling. Case studies are not necessarily representative of clinical outcomes in all cases as individual results may vary.
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