General Information
What is stress urinary incontinence (SUI)?
Urinary incontinence is involuntary leakage of urine. SUI is leakage of urine that occurs with increased abdominal pressure, such as with coughing, sneezing, or laughing.
What causes SUI?
The most common cause of SUI in men is radical prostatectomy (removal of the prostate for prostate cancer).
Other causes of SUI include pelvic fracture with injury to the urethra, surgery on the prostate for benign (non-cancerous) enlargement, and radiation treatment.
Incidence rates range widely and it is hard to predict who may experience bothersome SUI after a prostate procedure.
How is SUI diagnosed?
If you are still experiencing bothersome leakage more than a year after prostate surgery, your physician may ask some additional questions or do a minor procedure to evaluate which treatment option may be best for you.
Voiding diary – keep track of how much you are drinking, what you are drinking, episodes of incontinence, and when you urinate into the toilet.
Pad history – how many pads are you soaking through a day?
Cystoscopy – a minor office procedure that involves inserting a small camera into the urethra to evaluate how well the sphincter works and also to look for any scar tissue that may have formed as a result of your prior surgery or radiation.
What are my options for treatment?
Men with mild SUI may do well with external devices, such as a Cunningham clamp or a condom catheter.
Pelvic floor physical therapy can teach you how to control your pelvic floor muscles to decrease your leakage.
The most well-studied surgical option for treatment of SUI is the artificial urinary sphincter (AUS).
What is an artificial urinary sphincter (AUS)?
The device is designed to help control the flow of urine from the bladder by mimicking the natural function of the urethral sphincter, which is a muscle that contracts to hold urine in the bladder and relaxes to allow urine to pass out of the body.
The artificial urinary sphincter is made up of three components:
A cuff that is placed around the urethra.
A pressure-regulating balloon that is implanted in the abdomen, behind the abdominal wall muscles.
A control pump that is implanted in the scrotum.
The cuff is filled with fluid and wrapped around the urethra, and when it is inflated by the pressure-regulating balloon, it compresses the urethra and prevents urine from leaking out of the bladder.
When the patient needs to urinate, they use the control pump in the scrotum to deflate the cuff, allowing urine to pass through the urethra and out of the body.
The device is placed through two incisions, one in the perineum (between the anus and the scrotum) and the other in the lower abdomen.
What are risks and complications of AUS placement?
Infection: There is a risk of infection with any surgical procedure, and this risk increases when a medical device is implanted. Infection can occur at the site of the incision or around the device itself. If infection occurs, sometimes antibiotics are sufficient but usually the device must be removed.
Rates of infection are 5-8% and increase with each subsequent device removal and replacement.
Bleeding: AUS placement involves making incisions in the body, and there is a risk of bleeding during or after the surgery.
Device failure: Although AUS devices are designed to be durable and long-lasting, there is a small risk of device failure over time. This can include leaks, malfunctions, or problems with the control pump.
Mechanical failure rates range from 2% to 13.8% in long-term studies.
Incontinence: In some cases, patients may still experience urinary leakage or other symptoms. The goal is improved continence, not perfect continence.
About 80% of patients require 1 pad or 0 pads per day after AUS placement.
Urethral atrophy, or shrinking of the urethra due to pressure, occurs in about 8% of patients and may lead to recurrent leakage.
Erosion of the device: The cuff of the AUS may erode into the urethra and can cause problems with infection and difficulty urinating. This complication requires surgical removal of the AUS.
Rates of erosion average around 8.5% and is most likely to occur within the first 2 years after placement.
Post-Operative Instructions
Wound Care
You may shower the day after surgery. Do not scrub your incisions.
No baths or submersion in water for 2 weeks.
Leave the upper (abdominal) incision open to air. The skin glue and sutures will dissolve on their own.
The sutures in the perineum (area behind the scrotum) will dissolve on their own in 4-6 weeks.
Multiple times per day, tug on the tubing above the scrotal pump to bring it down into the scrotum. This helps to prevent retraction of the pump into the groin, where it will be more difficult to access in the future.
Medications
Take Tylenol and ibuprofen for pain. If this is not adequate, please take prescription pain medication. It is expected that you will need some prescription pain medication in the first week.
Please take your prescribed antibiotic for 5 days. It is also strongly encouraged to take a probiotic during this time to preserve the good bacteria in the intestinal tract. These can be obtained over the counter.
Take stool softeners twice daily to avoid straining. Hold this medication for loose stools/diarrhea.
Activity
Walking and climbing stairs are OK.
No strenuous physical activity or heavy lifting >10 pounds for 2 weeks after surgery. This includes shoveling snow, mowing the lawn, raking leaves, etc.
No straddle activities that place pressure on the perineum, like bike riding, for 4 weeks.
You may not drive or operative machinery when taking narcotic pain meds.
Continue ice as much as possible for the first several days after surgery.
Continue scrotal support/jock strap as much as possible for 1 week.
Follow-up
First appointment is approximately 2 weeks after surgery for a wound check.
Your appointment for device activation will be 4 weeks after your wound check (approximately 6 weeks after your surgery). You will continue to leak just as you did pre-op during this time.