Treatment options for male stress incontinence



There are a number of options and if one is unacceptable or unsuccessful others may be considered.

They are listed in order of the degree of invasiveness

Absorbent Pads.

These are placed in the underpants to absorb urine that leaks. They of course do not contribute towards a solution to the leaking.

Collection devices.

There are many types, such as a sheath fitted onto the penis. This will have a tube at the end to connect to a leg urine bag or to a valve which can be closed until the bladder fills and which can then be opened to empty the bladder. Otherwise catheters inserted into the bladder to drain the urine may be used. Again these do not lead to a solution.

Biofeedback or Electrostimulation

These are methods of exercising the pelvic floor muscles with the hope that the stronger muscles will overcome the leakage. An intensive series of treatments exercising the muscles through a probe placed in the anal canal can result in improvement or cure for a minority of suitable cases. If successful, muscle tone needs to be maintained by continuing less intensive exercising.

Urethral bulking

This involves injecting a bulking material in the urethra near the bladder neck to cause an obstruction of the urine flow. Unfortunately results for men have been shown to be poor.

Male Sling

Your urologist may select the TOMS (Trans Obturator Male Sling) which has some advanced features in the design of the tape. The results in clinical trials have been very good.

No surgery can be successful in every case. In clinical trials dating back to 2004 the results consistently show that more than 70% of men are satisfied with the results.

The surgery involves making an incision below the scrotum then threading the special tape through each side of the hip bone.

There will then be a small cut with a few stitches below the scrotum and a very small cut on each side which do not need stitches.

The surgery usually takes from 30-40 minutes and no more than an overnight stay in hospital is usual. A catheter will usually be placed in the bladder in the operating theatre and then removed before you leave the hospital.

Most men are dry immediately after surgery.

Your urologist will recommend that you resume normal activity after a few days but that you avoid heavy lifting, strenuous exercise — including biking — and intercourse for a minimum of six weeks.

Risk Information

In general, the risks are minimal. However, as with any surgical procedure, some inherent risks are present. Although rare, the most severe risks include infection. Erosion of the sling is a risk although this has never been reported with the TOMS up to the date of this sheet.

As with any procedure, surgical, physical, psychological, or mechanical, complications may occur that could necessitate revision or removal of the sling.

Artificial Sphincter

This involves a fairly major surgical procedure where a cuff is positioned around the urethra, a pump is fitted in the scrotum, and a fluid reservoir is placed in the lower abdomen. The whole system is filled with saline (a salt solution). To open the cuff to allow the passage of urine the pump in the scrotum is pressed and the saline runs into the reservoir. After the bladder is empty, the pump is used to pump up the cuff around the urethra and block the passage of urine.

The Artificial Sphincter works well in most cases. There is always a chance of mechanical failure which requires further surgery to replace one or more components. Few Artificial Sphincters last more than 10 years without problems.

The Artificial Sphincter is the “gold standard” solution for very severe incontinence. For mild to moderate incontinence there is a better less invasive non mechanical implant (a male sling) that is very successful.