Male incontinence is usually associated with surgery for prostate cancer. In this operation the entire prostate is removed and the bladder is then joined to the urethra to restore the flow of urine. The front of the prostate is close to the sphincter mechanism that controls continence and even in an uncomplicated procedure the sphincter mechanism may be weak or possibly even damaged resulting in urinary leakage.
In most cases men leak only a small amount of urine and with the use of pelvic floor exercises this can be minimised. There are some men however who continue to leak which can interfere with their quality of life. They may be required to wear pads in their underwear and in many cases if the leakage is not severe this may be sufficient.
In men who have a small degree of leakage that does interfere with their quality of life there are two main procedures that can be undertaken to correct this. The first involves the placement of a sling under the urethra for extra support. This procedure usually involves an overnight stay in hospital and is generally a minor procedure. For this to be successful however it is necessary for the man to be able to stop his urine flow during voiding to ensure that there is a good base line sphincter muscle competency.
For men with severe leakage that causes significant impairment of their quality of life, an artificial urinary sphincter is probably indicated. This is a surgical procedure that involves the placement of an inflatable cuff around the urethra tube. This is connected to a small pump in the scrotum as well as a small reservoir that sits behind the pubic bone. Generally this device can be placed via a single incision in the scrotum. In the normal resting position the cuff is inflated, compressing the urethra and preventing leakage of urine. As the bladder fills and the patient develops an urge to pass urine, he can squeeze the pump device in the scrotum which deflates the cuff and allows urine to pass freely. The cuff automatically reinflates, again compressing the tube after the bladder has emptied.
This device works very well and is effective in controlling leakages.