What are the treatment options for male stress urinary incontinence (SUI)?
Both conservative and surgical treatment options are available for men with stress urinary incontinence (SUI).
The most common cause of male stress urinary (SUI) is now radical prostatectomy surgery for the treatment of prostate cancer. It is estimated that up to 60% of men will suffer from stress urinary incontinence in the early postoperative period after radical prostatectomy surgery. This is mild in most cases and decreases with the passage of time but around 4% of men can suffer significant ongoing leakage. The rates of stress urinary incontinence (SUI) reduce significantly in the first 3 months after surgery. By a year after radical prostatectomy surgery, around 14% of men experience stress urinary incontinence (SUI).
All men can benefit from conservative treatment options for stress urinary incontinence. Surgical treatments are considered in men with bothersome stress urinary incontinence (SUI) that persists more than a year after the time of radical prostatectomy or earlier in men who have very severe symptoms.
Conservative treatment options for Men with SUI
Men with stress urinary incontinence can benefit from non-surgical treatment options including:
- Pelvic floor muscle physiotherapy
- Correcting problems that cause chronic constipation and coughing
- Cutting out smoking
- Continence devices and aids
- Advice regarding the appropriate choice of continence aids can be provided through specialist Urology Nurses and specialist Continence Advisors.
- Options may include the use of pads and condom drainage (an external collecting device for urine).
Surgical treatment options for Men with SUI
Before considering surgery, a full assessment of stress incontinence should be made to determine an individual’s suitability for surgery and make a recommendation regarding type of surgery. Such assessment may include:
- Assessment of stress urinary incontinence (SUI)
- Assessment of urinary incontinence
- Urodynamic testing
Many surgical treatment options exist for men with bothersome stress urinary incontinence including:
- Injectable agents for stress urinary incontinence
- Sling surgery with suburethral slings specifically designed for male stress urinary incontinence
- Artificial urinary sphincter (AUS)
Overall the artificial urinary sphincter (AUS) is regarded as the “gold standard” treatment for severe male stress urinary incontinence (SUI) occurring after radical prostatectomy surgery. Slings, injectable agents and other devices are better suited to men experiencing mild to moderate stress incontinence.
What is a male sling for Men with SUI?
A male sling is a minimally invasive implantable device used to treat mild to moderate (based on incontinence pad usage and pad weights) male stress urinary incontinence (SUI) after prostatectomy.
Male slings are thought to treat male stress urinary incontinence (SUI) by a combination of dynamic compression of the urethra (urinary drainage pipe which passes through the penis) as well as repositioning of the section of urethra located just below the bladder.
Male slings are a minimally invasive surgery using a “passive” mechanism to treat male stress urinary incontinence (SUI) i.e. there is no device manipulation as occurs with the artificial urinary sphincter (AUS).
Like the material used in female slings to treat stress urinary incontinence (SUI), male slings are made of a small strip of medical mesh (polypropylene) similar to the material used in other surgery such as hernia repairs. The urethral sling material remains in the body permanently (i.e. it is not absorbed over time). The sling is placed under the urethra and exits through small incisions in the skin (in the inner thigh in men who have a transobturator sling).
The hospital stay is short with a fast recovery time after sling surgery although patients must avoid strenuous activity for 6 weeks after surgery to allow the sling to fix in position with scarring. The effects of surgery are immediate.
What are the different types of male sling for Men with SUI?
There are many different types of male slings available for men with stress urinary incontinence (SUI) including:
- 1st generation of male slings - bone anchored slings i.e. the sling is anchored to the bones of the pelvis using bone screws to provide compression of the urethra.
- 2nd generation of male slings:
- Slings with adjustable compression of the urethra
- Transobturator slings – which pass through the obturator muscles of the inner thigh. The AdVance® male sling (manufactured by AMS®) is one of the most commonly available male sling procedures for post prostatectomy male stress urinary incontinence (SUI).
What are the potential side effects of Male Sling surgery for Stress Incontinence?
All surgery for stress urinary incontinence has potential side effects.
Specific risks associated with male urethral sling surgery include:
- Failure to improve or rarely worsening of stress urinary incontinence
- Development of new overactive bladder (OAB) symptoms or worsening of pre-existing OAB symptoms such as frequency, urgency and nocturia
- Damage to nearby structures on insertion of the sling such as the urethra, blood vessels, nearby nerves
- Difficulty in urination which may result in a need to loosen or divide the sling
- Urinary tract infection
- Wound infection
- Small risk of pain in the inner thigh with a transobturator sling
- Small risk of problems related to the use of synthetic material e.g. erosion or exposure of the sling in the urethra
What are the outcomes of Male Sling surgery for Stress Incontinence?
The success rates in improving or curing stress urinary incontinence in appropriately selected patients range from 55% to 90% with low complication rates. The effectiveness of sling surgery can decline with time.
Long term data on mesh erosion with male urethral slings is unknown.