Fortunately, most men recover urinary control after prostate cancer surgery. However, every man is unique, and some may heal differently. I’m often asked to lecture on these issues. One such lecture can be seen by clicking HERE. Urine leakage with activity due to a weak sphincter is known as stress urinary incontinence (SUI). As a doctor who treats men for this condition, I look at the time since surgery and the severity of the problem. The survivorship protocol involves pelvic floor exercises after the cancer operation. If a man is steadily getting better over time, I typically wait a full year after his prostate operation before considering a procedure to restore control. If the problem is severe and not showing signs of improvement, I may intervene as early as 6 months after surgery.
When is a sling the better choice?
The male sling functions similarly to a hammock under the urethra. It adds support to reduce leakage (incontinence). This operation originated in women for the same condition, typically seen after childbirth or hysterectomy. The results are best in patients with milder degrees of incontinence. Patients who have had radiation are believed to be at higher risk for failure. They may be better managed with the artificial urinary sphincter (AUS). The sling is often preferred because patients don’t have to cycle a device. Also, the improvement is immediate.
With the AUS, you have to wait several weeks after surgery before activation. I typically look at the number of pads a man uses over 24 hours when he is fully active. I also look at his ability to contract his own sphincter to cut off his flow. A man without prior radiation who can still contract his sphincter and uses 2 pads or less per day is a great candidate.
When is the AUS the better choice?
The artificial urinary sphincter (AUS) has been around since the 1970s. It is the gold standard for treating male SUI. If men have had radiation therapy, the AUS may be the best option for treatment. The same is true if men require a large number of pads or diapers for their incontinence. Men receiving the AUS should have good manual dexterity. Patients with diabetes should have their blood sugar well controlled.
How do you choose a urologist for a sling or AUS?
Expertise is related to training and experience. There are low-volume implanters and high-volume implanters. High-volume implanters are generally preferred. Providers who are known for excellent outcomes are often asked to teach others. I was fortunate to train at a high-volume center in residency. After residency, I voluntarily completed two additional years of training in this type of surgery. I have developed unique surgical approaches for incontinence surgery and published numerous articles in this area and my outcomes are excellent. I previously published a guide for surgeons that is available online. You can find it by clicking HERE. Many of my patients volunteer to speak to other men who may be interested in a solution. If you’d like to see a video I produced on how to perform sling surgery, you can click HERE.
If I had a sling can I still have an AUS?
Yes. If a man has had a sling but still has some SUI, he can often have an AUS. I have been asked to see many men who have had prior sling surgery to consider them for AUS placement. I have always been able to place an AUS in these patients when desired.
Can you fix an AUS?
Some men come to see me because of recurrent SUI. I always try to learn as much as possible about prior surgeries, even if it was done many years ago. If a man has an AUS and has return of incontinence, we can determine the reason and find a solution. I have developed minimally-invasive techniques to correct these problems. I have also shown that urethral atrophy is a myth. Men may develop capsules under the AUS that constrict the urethra. You can see an image of this by clicking HERE. We can address these to allow for an easier solution than previously seen elsewhere. I’ve published this data. It can be found by clicking HERE. I’ve also produced a video to document the technique to correct this issue. You can see it by clicking HERE.