Douglas F. Milam M.D.
Urologic Surgery
Incontinence, or loss of urine, is more common in men than most people realize. Incontinence may be due to the natural process of aging leading to growth of the prostate, bladder overactivity, or changes that may occur to the bladder or continence mechanism from surgical procedures or radiation therapy.
Our first goal is to define the location of the problem causing the incontinence. For instance, incontinence caused by bladder overactivity is treated completely differently than incontinence caused by problems with the bladder outlet continence mechanism or sphincter. The urinary sphincter is a circular muscle that surrounds the urethra and squeezes the urethra closed preventing loss of urine. Sphincter dysfunction (ISD) is a common cause of incontinence in our male patients and often responds well to surgical treatment.
During your office visit we will take a history and perform a physical examination. If your incontinence is significant, urodynamic testing and cystoscopy will likely be needed to determine the site of the problem and to quantify the extent sphincter dysfunction (ISD).
We offer several surgical treatment options for incontinence in men. The choice of treatment is determined by the site and severity of your problem.
Treatment Options For Incontinence in Men
Sphincter Dysfunction (ISD) is the most common problem we see causing incontinence in men following prostate surgery.
a. Medications; There are a couple medications such as pseudoephedrine that have minimal benefit in the rare patient. Unfortunately, medications usually are of no benefit in patients with incontinence due to ISD.
b. Male Sling; The male sling is an effective therapy in appropriately selected individuals. A sling works by supporting the urethra causing the existing sphincter to function more effectively. This therapy is dependent on sufficient existing sphincter function. We find that patients with less than two pad per day incontinence and certain urodynamic parameters are good candidates for a male sling. Individuals with more than two pad per day incontinence are usually better served with an artificial urinary sphincter.
c. Artificial Urinary Sphincter (AUS); An artificial urinary sphincter is a device which is implanted in the operating room that causes the urethra to squeeze closed. Unlike a male sling, an AUS adds additional sphincter function and is therefore helpful in patients with greater incontinence. As a generalization, we use the AUS in patients presenting with 2 to 12 or more pad per day incontinence.
Bladder Overactivity (Bladder Contracts When It Is Not Supposed To) This is reasonably common after radiation therapy for prostate cancer, but much less common following prostate surgery.
a. Medications; This includes medicines such as oxybutinin, trospium, solifenacin, mirabegron, etc. These medications are often the first line treatment for bladder overactivity. If successful, they can decrease urinary frequency, urinary urgency, and urge incontinence. They work by decreasing involuntary bladder contraction. They do not improve urinary sphincter dysfunction (ISD). Patients with ISD typically have little if any benefit from these medications.
b. Botox Injection; You may know of Botox being used in the cosmetic surgery setting to relax facial wrinkles. The medication works by decreasing contraction of muscle. The same mechanism can be helpful in the bladder. Botox injection into the bladder wall can decrease the frequency and severity of involuntary bladder contraction. The procedure is typically done in the office through a flexible cystoscope. If successful, the effect lasts about 6 months. Botox is a procedure that requires periodic redosing.
c. Interstim; Interstim is a treatment where a device is implanted to stimulate the nerves that course to and from the bladder. It is effective for urinary frequency, urinary urgency, and urge incontinence. Most Interstim patients have tried and failed medications.
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