Male Urinary Incontinence

After radical prostatectomy (RP) surgery, most men will resolve their incontinence or urinary leakage problem at some point within the first year after surgery. However, some men will continue to require pads for protection and may need to consider other options.

Artificial Sphincter

Since 1972, we have had the option of using an artificial urinary sphincter in men whose post-RP incontinence is moderate to severe. The artificial sphincter is a fluid filled, surgically implanted device which places pressure around the urethra until the patient is ready to void; at that time, the patient squeezes a bulb in his scrotum to draw the fluid out of the device to allow urine to flow through the urethra. The device then slowly fills up with fluid again over several minutes.

Although the artificial sphincter remains the gold standard for the surgical treatment of post-RP incontinence, it does have some drawbacks. For one thing, it is a mechanical device which requires the patient to actively participate in scrotal pumping every time he wishes to void. For another, the patient must have the manual dexterity and mental capacity to do this.

Male Sling

We now have another more conservative option for treating mild, moderate, and sometimes severe post-RP incontinence: the Male Urethral Sling.

A significant benefit of the Sling is that there are no working parts that the patient has to manipulate in order to urinate. The sling can usually be put in during an outpatient procedure, and the catheter that is inserted during surgery is typically removed after 24 hours at home.

Rather than applying direct pressure to the urethra as in the older InVance sling, the current AdVance sling actually alters the position of the urethra during straining or physical activity to prevent leakage and requires no bone anchors. We do ask patients to avoid lifting, straining, squatting, etc. for 4 to 6 weeks after the surgery.

Placement of the sling does not prevent future placement of an artificial sphincter if needed.

Although not every patient is a candidate for the above slings, the availability of these more conservative treatment options for post-RP incontinence has created a high degree of interest.