By. Dr Kristi Hebert
Stress urinary incontinence after prostatectomy or pelvic radiation therapy is a common and often frustrating side effect of treatment for thousands of men. Symptoms include loss of urine control with increased abdominal effort, such as coughing, sneezing, heavy lifting, and exercise. Stress incontinence can improve with dedicated pelvic floor physical therapy to strengthen the external urethral sphincter muscle. However, for some men, this treatment alone is not effective. There are surgical interventions that can offer significant improvement or resolution of incontinence, and restore quality of life in those men who find this distressing. In the article, we will discuss two of these options.
AdVance™ XP Male Sling System
The AdVance™ XP male sling is a urethral sling composed of mesh and surgically implanted to reposition and support the urethra, decreasing or curing urinary incontinence in 63–83% of patients. It is a static device that has no moving parts or mechanical components, so this can be used in men with limited hand dexterity or memory difficulties. It is ideal to use in cases of mild to moderate incontinence when there has been no radiation treatment.
AMS 800™ Urinary Control System
The artificial urinary sphincter AMS 800™ is a 3-component silicone device surgically implanted and completely concealed internally. The cuff surrounds the urethra to provide compression, preventing urine from traveling through the urethra during increased abdominal effort. The pump is placed within the scrotum, allowing patient control of the device. To initiate urine flow, the patient manually squeezes the pump in order to open the cuff and release the urethral compression. The balloon is implanted in the pelvis and stores the saline during times that the cuff is open. This device provides great urinary control and high patient satisfaction rates for all degrees of stress urinary incontinence and is highly effective in cases of radiation therapy. Published success rates range from 59-90%.
Bauer RM, Kretschmer A, Stief CG, et al. AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence. World J Urol. 2015 Jan;33(1):145-50.
Kahlon B, Baverstock RJ, Carlson K. Quality of life and patient satisfaction after artificial urinary sphincter. Can Urol Assoc J. 2011;5(4):268-272.