Surgical treatment of male urinary incontinence

Patients with bladder sphincter impairment are fearful of coughing, sneezing, laughing, or lifting.

Following radical prostatectomy, severe urinary incontinence is estimated to occur in approximately 5% of men, and an artificial urinary sphincter is the gold standard of care for such patients.

75% of patients with artificial urinary sphincters achieve dryness and 25% have marked improvement.

There is a failure rate of first-time sphincters of 25% to 30%, due to erosion, urethral atrophy, or infections.

For artificial urinary sphincter failures tandem cuffs can be placed to increase sphincter control.

In the transcorpal cuff procedure part of the corpus cavernosum is cuffed, and approximately 65% of patients achieve dryness, 30% have improved symptoms.

In the above procedure 5% have complications such as device malfunction, and infection requiring device explantation.

Patients with light leakage are generally good candidates for a suburethral sling, whereby a sling is implanted underneath the bulbous urethra to elevate and compress it, preventing leakage.

With the suburethral sling 60% to 70% of patients achieve dryness, 20% have markedly improved symptoms, and 10% have minimal improvement.

In patients who have had irradiation or transurethral resection of the prostate, the suburethral sling procedure may be less successful.

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