Post-Prostatectomy Urinary Incontinence

Post-Prostatectomy Urinary Incontinence

Post-prostatectomy urinary incontinence (PPI) is the term used to identify the involuntary leakage of urine following radical prostatectomy to treat prostate cancer.   PPI represents a specific form of stress urinary incontinence where increased abdominal pressure from a cough, sneeze, or simple physical straining results in the leakage of urine.  Under normal conditions, this increase in abdominal pressure is managed uneventfully by contraction of the external urinary sphincter, the muscle surrounding the early part of the male urethra, preventing loss of urinary control.  During PPI, this sphincter mechanism is insufficient in maintaining closure of the urethra, permitting urinary leakage.  

Between 5-10% of patients undergoing radical retropubic prostatectomy for prostate cancer will suffer clinically significant PPI, manageable only with additional therapy.  As many as 30% of patients undergoing prostate cancer surgery will notice some degree of urinary incontinence postoperatively.  The majority of these patients will, however, regain urinary control within the first post-operative year and require no additional therapy.  If after 9-12 months the patient is dissatisfied with his level of urinary control, a discussion of the artificial urinary sphincter (AUS-800) is appropriate.  The AUS-800 represents the most effective cure for PPI.  Over 90% of patients report satisfactory urinary control following implantation and a similar percentage of patients report that they would both undergo the procedure again and would recommend implantation to a friend suffering similar difficulties.  The AUS-800 can be implanted in under 1 hour through a single small incision in the scrotum which heals with a nearly imperceptible scar.  There are no externalized components and to the casual observer, as in a public shower or restroom facility, it is completely unnoticeable.

Artificial Urinary Sphincter

The AUS-800 is a device known as the artificial urinary sphincter.  This device is placed completely inside the patient's body to provide simple, discreet urinary control. The patient controls urination simply by squeezing a small pump. The AUS-800 has proven to be effective in treating urinary incontinence and is considered the gold standard by most urologists. With this device, most patients remain dry with only minor leaks or dribbles of urine, usually during strenuous exercise or exertion. As with any medical procedure, the AUS-800 is not 100% effective in all patients. Some patients may require additional protection.

AdVance Trans-obturator Male Sling for Urinary Incontinence

The AdVance™ Male Sling System from AMS is an innovative, safe and effective procedure for men suffering from mild stress urinary incontinence. AdVance is a minimally invasive outpatient surgery that can restore bladder control the day it is performed.

While moderate to severe cases of incontinence in men have been treated surgically for years, the majority of incontinent men — those only mildly incontinent — have had few attractive medical options until now.

Worldwide, 55 million men suffer from incontinence; 5 million men in the United States. AdVance is a treatment for mild stress urinary incontinence (SUI), a condition in which urine is leaked during physical activity like lifting, exercising, sneezing and coughing. Most are prostate cancer survivors, having undergone surgery for the treatment of their cancer with the often unavoidable outcome of a damaged urinary sphincter. With the advent of the AdVance male sling system, doctors are now able to offer a viable spectrum of incontinence solutions.

AdVance gives physicians the opportunity to provide real incontinence solutions to even more prostate cancer survivors.

With the AdVance procedure, a small "sling" made of synthetic mesh is placed inside the body through small incisions. The sling supports the urethra, restoring normal bladder control. Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities shortly thereafter.

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