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Male Incontinence


Definition:

Urinary incontinence (UI) is a distressing and serious health problem. Its psychosocial and economic burden leads to significant quality of life issues. UI is more prevalent than hypertension, depression and diabetes, yet underreported with fewer than half of all patients willing to report their symptoms to their physicians. The urological surgeons at The University of Kansas Hospital are skilled at diagnosis and treatment of these conditions. The three most common types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), or a combination of both, mixed urinary incontinence (MUI). The International Continence Society defines incontinence in the following way:

  • Stress incontinence: Is involuntary leakage on effort or exertion, or on sneezing or coughing.
  • Urge incontinence:  refers to involuntary leakage accompanied by or immediately preceded by urgency.
  • Mixed incontinence:  is defined as a complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing.

Signs and symptoms:

Most men who experience urinary leakage will have symptoms based on their type of incontinence. In order to maintain proper control a complex series of interactions must take place in the body including closing of the urinary sphincter muscle, proper bladder filling, and finally intact sensation and motor function.

  • Stress incontinence: This type of incontinence results in a weakness of the urinary sphincter and typically involves leakage during activities such as coughing, laughing, sneezing, exercise, and position changes.  Patients will describe squirts of urine that occur with activity. In severe cases the leakage may be constant.
  • Urge incontinence: This type of incontinence results from the inability of the bladder to hold urine and results in uncontrolled urination associated with or preceded by a feeling of urgency.
  • Mixed incontinence: This is a combination of both urge and stress incontinence.

Causes:

The cause for underlying incontinence must be properly determined prior to initiating therapy.

  • Stress incontinence: is most often due to side effects of surgical treatment for benign prostatic hypertrophy, prostate or bladder cancer.  Injury to the urinary sphincteric mechanism (rhabdosphincter) is thought to be the main mechanism and results in the inability to hold urine due to a weakened muscle.
  • Urge incontinence: is considered classically due to an overactive bladder muscle (OAB). The underlying pathophysiology of OAB can relate to alterations in any of the reflex cycles in normal urination or structural changes in the smooth muscle, nerves or lining of the bladder. Treatment of OAB is based on diagnosis after excluding other pathologies, i.e. urinary tract infection, bladder stone, and diabetes.

Diagnosis:

Patient evaluation starts with a thorough history and physical.  The majority of patients can be diagnosed based on their symptoms.  Additional tests may be required to help plan treatment including urodynamic studies which measure pressure within the urinary system, bladder and sphincter function, presence of overactive bladder, and bladder capacity.  Other additional tests can include insertion of a camera into the bladder called cystoscopy.


Treatment:

At Kansas University Medical Center, the treatment for male incontinence is customized to fit each individual patient.

  • Stress incontinence: Following prostate surgery, bladder surgery, or radiation, men are encouraged to attempt active conservative management (fluid restriction, medication management and pelvic floor exercises, Kegels).   If these conservative measures fail Dr. Josh Broghammer and Dr. Priya Padmanabhan provide surgical intervention for treating persistently bothersome male stress incontinence.  The main surgical techniques are as follows:
  • Bulking agents: Endoscopic management includes injections of agents under the lining of the urethra to narrow the inside lumen to help aid in holding urine.  These procedures can be performed as an outpatient, require no incisions, but have limited success.
  • Male sling: Male slings using either the InVance or Advance systems help to provide increased control for those with light stress urinary incontinence, generally less than three pads per day.  These minimally invasive techniques can be performed with a simple overnight stay in the hospital.
  • Artificial Urinary Sphincter (AUS): The artificial sphincter is the gold standard of intervention for male stress incontinence.  It is a proven and effective treatment for mild to severe incontinence.  A ring called a cuff is wrapped around the urethra to provide extra pressure to hold in urine.  There is an implantable pump placed within the scrotum, under the skin, which is pumped to allow the patient to pee.


SATISFYING SOLUTIONS Effective Treatments for Male Incontinence

Incontinence can limit your activities; keep you homebound; in costly, messy pads; dealing with the frustration and embarrassment, and the constant fear of leaking and odor. The reality is, you don't have to live with bladder control problems anymore.

Our practice specializes in real solutions… from minimally-invasive surgical procedures like the male sling for mild to moderate incontinence, to the gold standard artificial urinary sphincter implant that can resolve even severe incontinence.



MILD TO MODERATE INCONTINENCE

AdVance® Male Sling System
  • Small sling made of synthetic mesh placed inside the body through small incisions
  • Supports the urethra, restoring normal bladder control
  • Most patients are continent immediately following the procedure
  • Can resume normal, non-strenuous activities shortly thereafter


MILD TO MODERATE INCONTINENCE

InVance® Male Sling System
  • Also involves placing a mesh sling completely inside the body
  • Places pressure on the urethra to reduce the possibility of urine leakage
  • Most patients are continent immediately following the procedure
  • Can resume normal, non-strenuous activities shortly thereafter


MODERATE TO SEVERE INCONTINENCE

AMS 800® Urinary Control System
  • Artificial urinary sphincter placed completely inside the body
  • Provides simple, discreet urinary control
  • Mimics a healthy sphincter, keeping the urethra closed until you want to urinate
  • Connected system of:
    • Pump implanted in the scrotum
    • Inflatable cuff around the urethra
    • Balloon reservoir implanted in the abdomen


HOW IT WORKS

  1. Control urination by squeezing and releasing the pump
  2. Moves fluid out of the cuff and back into the reservoir
  3. Urine can flow out of the bladder
  4. Fluid returns from reservoir to cuff, squeezing urethra closed again

Make an Appointment to Learn More

If you suffer from incontinence, don’t wait another day. Make an appointment to talk about your options for a permanent solution that can help you restore your quality of life…and live life dry!

As with any surgical procedure, inherent risks are present. Although rare, some of the most severe risks may include infection and erosion, surgical, physical, psychological or mechanical complication. If these occur, they may necessitate revision or removal of the device. For additional product and risk information, Contact Us today.


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