Overview
Bulking agents:
This is a simple procedure where a substance is injected into the area of the urethra and, in theory, should tighten the area and reduce the degree of leakage. In theory, it sounds great. But in reality it does not work and should NOT be performed for male stress incontinence. In fact, the International Continence Society went so far as to state that bulking agents have no role in treating male incontinence. The procedure was designed for the treatment of leakage in women; however, it has shown no benefit in men. If you have been counselled to undergo this procedure for your stress urinary incontinence, it would probably be a good idea to seek a second opinion for your leakage problem.
Botox Bladder Injections:
This treatment is for “overactive bladder” and not for stress incontinence. It is very good for treating severe urgency of urination but plays no role in the treatment of stress incontinence.
Stem Cells:
To date, there is no evidence that stem cell therapy has been able to treat male stress incontinence. In the future this may become a suitable option but this treatment remains many years in the future.
Electrical Stimulation (InterStim®):
This procedure is not designed to treat stress urinary incontinence in men or women. This procedure is designed to treat urinary urgency and urge incontinence. If you have been counselled to undergo this procedure for your stress urinary incontinence, it would probably be a good idea to seek a second opinion for your leakage problem.
Male Sling:
This is a procedure performed on men with small volume (light) leakage. Also, it is only for men who have NOT had radiation therapy for prostate cancer. In properly selected men, the male sling provides a nice option for treating stress incontinence. Usually the procedure is performed as an outpatient. As with any procedure, complications can occur but with an experienced surgeon these complication should be rare. When complications do occur, they require advanced level evaluations and treatment.
Artificial urinary sphincter:
For men with moderate to heavy urine leakage with activity and for men who have had radiation for prostate cancer, the artificial urinary sphincter (AMS 800®) has been the gold standard for treating men since it was introduced in 1972.
The procedure requires a detailed evaluation and counselling to consider if you are a good candidate. However, in experienced hands, the procedure can be performed safely and rapidly in the hospital. It is very important for a man considering this option that they choose a surgeon who has extensive experience in the evaluation and implantation of the device. In two recent studies, it was shown that the surgeon needs to have performed at least 200 implantations in order to significantly reduce the risk of complications. Unfortunately a large number of surgeries are performed by surgeons who perform less than 1 artificial sphincter procedure a year and a higher preventable complication rate has been seen as a result.
Briefly, the artificial sphincter works by using a small, fluid-filled ring (or cuff) which is implanted around the urethra (the tube you urinate through) to keep the urinary sphincter shut until you're ready to urinate [see image]. To urinate, the process is quite simple… you press a valve (called a pump) implanted under your skin in your scrotum. When this pump has been pressed it causes the cuff around the urethra to deflate. This allows your urine to flow out of your bladder. The Mayo Clinic Rochester has the world’s largest experience dealing with the artificial urinary sphincter with well over 3,000 procedures performed dating back to 1972. Drawing on this experience we have been able to increase the success rate and greatly reduce the infection rate associated with the procedure.
In properly selected men, the artificial sphincter can be life-changing! Men can regain normal or near normal activities without the fear of urinary leakage. The device is not perfect and may require repairs, but in experienced hands and with appropriate patient expectations, it can restore a man to nearly the way he was before his prostate surgery.
As stated above, it is essential for you to choose an experience doctor to treat your urinary incontinence. Complications can happen with any surgery and at any institution. However, reducing or eliminating needless or avoidable complications come with experience. Mayo has nearly 50 years and over 3,000 procedures of experience with the evaluation, counselling and treatment of men with urinary incontinence.
