Male Incontinence After Prostate Surgery

Male stress urinary incontinence

Male stress urinary incontinence (SUI) is leakage of urine with sneezing, coughing, laughing, lifting or standing up — actions that put pressure on the bladder. It has nothing to do with psychological stress; it happens when the external sphincter, the muscle that holds urine in, has been weakened.

Why it happens

Prostate cancer treatment is the most common cause. Radical prostatectomy, radiation (external beam or brachytherapy), or a combination can affect the sphincter, and about 1 in 10 men still have persistent leakage one year after prostatectomy. Pelvic trauma — a car accident, fall or straddle injury that damages the urethra — is another cause, and transurethral prostate surgery occasionally contributes.

If you are among these men, you are not alone, and you do not have to manage with pads indefinitely.

Treatment options

• Pelvic-floor physical therapy — the first step for mild leakage in the first year after surgery
• Pads, absorbent underwear, or a penile clamp — management, not treatment; each needs daily attention
• Male sling (such as the AdVance™ XP) — a soft mesh implant that repositions and supports the urethra; best for mild-to-moderate leakage, with an outpatient procedure and recovery in one to two weeks
• Artificial urinary sphincter (AMS 800™) — an inflatable cuff around the urethra, a small pump in the scrotum, and a fluid reservoir; the patient squeezes the pump to urinate and the cuff refills automatically. It is the reference-standard treatment for moderate-to-severe leakage, and in a survey of 1,082 men, 94% who received one would recommend the surgery to a friend or family member.

Dr. Sosenko's residency included prosthetic urology, so he can evaluate leakage after prostate treatment, perform the testing that distinguishes sphincter weakness from bladder overactivity, and offer both the sling and the artificial sphincter. Erectile dysfunction after prostate treatment is frequently addressed at the same time — see the erectile dysfunction and penile prosthesis pages.

Patient resources

• FixIncontinence.com — patient education on male SUI, including the DRY docuseries, the AMS 800™ artificial urinary sphincter and the AdVance™ XP male sling
• Fix Your Incontinence — patient brochure (PDF)
• Life after prostate cancer — brochure (PDF)
• Male sling and artificial sphincter FAQ (PDF)

Statistics, animation and downloadable materials provided by Boston Scientific. Talk to Dr. Sosenko for a complete discussion of risks, benefits and alternatives.