General Urology

Male Urinary Leakage

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Treatment of Male Stress Incontinence

What is stress incontinence?

Stress incontinence is leaking related to “stress” such as coughing, jumping, standing, walking or exercise. Leaking at night while sleeping is rare but can sometimes be a more severe form of incontinence. Stress incontinence is very common immediately after prostate cancer treatments but tends to improve gradually over time. Typically, the most improvement will be seen the first 6 to 12 months after your prostate cancer treatment. Robotic surgery has improved stress incontinence rates to less than 10%.

Early treatments for stress Incontinence

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Urinary leaking has been shown to improve quicker with kegel (urinary sphincter strengthening) exercises. These exercises should be started prior to your prostate cancer treatment or as soon as possible after surgery to expedite your continence recovery.

To do a Kegel exercise, follow these steps:

Start by holding your pelvic floor muscles in for 5 seconds. To pull in your pelvic floor, think of pulling in and lifting up your genitals (it’s the motion you make when you try to stop your urinary stream during voiding).
After holding for 5 seconds, slowly and completely relax your muscles for 5 seconds.
Repeat this process 10 times, at least 3 times every day.
Consider seeing a pelvic floor physical therapist for more intensive pelvic floor strengthening.

2

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Surgical treatments for persistent stress incontinence

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Male Mid-Urethral Sling

A mid-urethral sling is an outpatient surgery
designed to place a mesh support to add back the
resistance that was previously lost when you underwent prostate cancer treatment.
In essence it is like kinking a hose to make it less likely that you leak with “stress” activities.
Patients with mild to moderate stress incontinence
(3 or less pads per day) or patients with
leaking primarily with sex (climacturia) are most likely to benefit from this.
Data shows 67% of patients who undergo a sling will be down to using 1 pad or less for their incontinence support (most use a just incase pad or thick underwear) after their sling surgery.

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Artificial Urinary Sphincter (“AUS”)

This is often considered the gold standard for men who have stress incontinence after their prostate cancer treatment.
The AUS is an outpatient surgery which involves placement of a balloon around the urethra (hose that drains the bladder) which acts as a make-shift urinary sphincter. It has a pump in the scrotum and a balloon in the pelvis. It requires squeezing of the pump to open the balloon and allow you to empty your bladder.
Data shows 94% of patients are down to 1 teaspoon or less of leaking a day, regardless of the severity of their incontinence.
This device generally lasts 5-10 years before requiring a revision surgery.