Male Incontinence Treatments
Treatment options for stress urinary incontinence
Male sling: The goal of the male sling is to help pull the urethra into the body in order to enhance the function of the external sphincter. It is important to have a functioning sphincter before having a sling placed. There are currently two male slings on the market, the first is made by AMS and is called the Advance Sling. This sling wraps around the inferior pubic rami at the level of the bulbar urethra.
The second is made by Coloplast and is called the Virtue Sling. The virtue also has arms that wrap around the inferior pubic rami, but it also features prepubic arms. The goal of the secondary arms is to add compression to the urethra.
Results of these two slings is similar, however, there have been no comparative trials.
Artificial urinary sphincter: The artificial urinary sphincter has been around since the 1970s, so there have been multiple modifications to this device. However, the function has always been the same; to mimic the actions of the natural sphincter.
To implement the artificial urinary sphincter, incisions are placed in the perineum (the area between the anus and the scrotum) and low abdomen. Then, a cuff full of fluid is placed around the urethra to obstruct it. Next, a small balloon that holds fluid is placed in the abdomen. Finally, a pump sits in the scrotum that controls where the fluid goes. When a man needs to urinate, the pump in the scrotum is pressed, the fluid in the cuff moves from the cuff to the balloon, the urethra is opened and the urine is able to pass.
Prostate removal: In a normal male, the bladder neck and the prostate are closed at rest, as are the muscles of the external sphincter. When the prostate is removed, the bladder neck will no longer be closed at rest and with the prostate gone, the external sphincter is left to control urine. In some men, this is not enough to hold the urine back when coughing or sneezing.
Transurethral resection of the prostate (TURP): After a procedure for enlarged prostate, there can be several causes to stress incontinence. First, if there is damage to the sphincter muscle, then there can be stress urinary incontinence. Generally, this incontinence will not get better over time.
A second reason that incontinence may occur after a TURP is because the bladder is not used to having such a small amount of resistance and the sphincter muscle is not strong enough to control the urine. In this case, most patients improve over time. Reasons that people may not get better include older age and a long history of bladder issues prior to surgery.
Urge urinary incontinence treatments
Once the cause of the leakage is determined, doctors can directly target the best treatment option. Treatment options include:
Medications: Anticholinegics are a class of medications that target the bladder receptors responsible for contraction. A new class of medication called mirabegron targets and activates the receptors in the bladder responsible for relaxation. These are the best oral medications for an overactive bladder.
Botox injection: In patients who fail oral medication, a different option is Botox injection. Botox prevents the muscles of the bladder from contracting. The improvements from this treatment are not permanent and often require repeat injections.
Neurmodulation: Interstim is a device implanted into the low back that sends pulses of electricity along the nerves that supply the bladder. This device is effective in some patients who have failed oral therapy. When this treatment is successful, the results last for quite some time.
In addition there is a form of neuromodulation called tibial nerve stimulation. Here, rather than a continuous pulse to the nerves of the bladder, we target a nerve that is all the way down in the leg near the ankle. Patients opting for this treatment come in periodically and often require maintenance treatments to maintain success.