The surgical treatment options for SUI include a male urethral sling and an artificial urinary sphincter. These procedures should be done by a urologist with specialized training for these procedures.
Work Up
If you have SUI, please discuss your symptoms with your urologist. You will need to tell them when and how much you leak and how many pads you use and how wet they are when you change them. You may be asked to keep a diary of urinating (peeing) habits, including how much fluid you take in. After finding out how much you are leaking, your doctor will need to do a cystoscopy. This means a very small camera will be inserted through your urethra into your bladder to look at your urethra, urethral sphincter, and bladder. With all this information, your urologist will decide which surgical option is best for you. Your urologist may also prescribe pelvic floor physical therapy to help make your surgical outcome better.
Male Urethral Sling
A male urethral sling is a piece of mesh that is placed over the urethra to support to the urethra which prevents SUI. These are often used for patients with mild to moderate SUI. Slings are not the best option for patients that have had radiation treatment because of changes to the tissues from this treatment.
There are two types of slings available—the two-arm sling and the quadratic (four-arm) sling. Choosing which sling to use is based on which one your urologist prefers and the amount of leaking you have. The two-arm sling is smaller and elevates or lifts the urethra to stop the leaking. The quadratic sling is larger so it can lift and squeeze the urethra. One difference between slings and artificial urinary sphincters (described below) is that you don’t have to use your hands to make the sling work. Another difference is that the patient will see an improvement in continence (ability to hold urine) soon after surgery.
Artificial Urinary Sphincter (AUS)
An AUS is a device made of three parts—a cuff, pump, and balloon. The cuff that is wrapped around the urethra mimics, or acts like, your natural urethral sphincter. The pump is placed in the scrotum next to the testicle during surgery. At rest, the sphincter is closed. It squeezes the urethra closed to stop urine from leaking. When you feel like you need to urinate, you squeeze the small pump and it opens the sphincter to allow urine to pass through the urethra. After 90 seconds, the sphincter closes on its own. This prevents any further leaking or passing of urine until the pump is squeezed again.
AUS is considered the gold standard for the treatment of SUI. It is typically used on patients with moderate to severe SUI. This is also the treatment of choice for patients that have had radiation therapy for prostate cancer. Unlike the sling, the AUS will not be “activated” or turned on to prevent SUI right after the surgery. This is because the urethra needs time to heal before applying pressure on it with the AUS. You will visit your urologist's office about six weeks after surgery to activate it.
Conclusions
The ability to control when you urinate or pee is something many people may take for granted. Unfortunately, many prostate cancer survivors are dealing with incontinence due to the treatment they have received. For patients with leakage that is too severe for non-surgical options, a sling or an AUS can allow the patient to control their continence again. These surgical options can be used along with non-surgical options to improve urine control. Pelvic floor physical therapy is a non-surgical option that is often used with surgical options. If you are interested in having one of these procedures, it is important to find a urologist who is an expert in placing a sling and/or AUS.