Incontinence Surgery for Men

There’s no question that all types of surgery carry risk. Complications like infection, bleeding and damage to surrounding tissue and nerves are possibilities, so it’s usually only considered for incontinence after non-invasive treatments have failed, and the condition is interfering with the individual’s quality of life.

Conservative (non-invasive) options include:

• Lifestyle changes such as losing weight or quitting smoking
• Pelvic floor muscle exercises, including specialist physiotherapy
• Bladder retraining

When surgery may be considered
For men, surgery is often required if they have prostate cancer, (which is separate from incontinence surgery) and of course, any treatment must be discussed in detail with your doctor. You can read more about treatments for prostate cancer on the Australian Government’s Cancer Australia website.

The prostate gland sits below the bladder and around the urethra (the tube that transports urine outside the body from the bladder) so it makes sense that if it is enlarged, it can restrict urine flow. Restricted flow can cause Overflow Incontinence, which may be the first sign that things aren’t right, so it should never be ignored. And bear in mind that not all enlarged prostates are cancerous.

The decision to undergo an operation to correct continence issues should never be taken lightly as it carries risks like bleeding, infection and damage to the surrounding area. It’s the reason why doctors tend to exhaust conservative options first.

Persistent continence issues can be the result of a weak pelvic floor muscle – often after prostate surgery. If the muscle is weak, control (the ability to ‘hang on’) can be compromised. This is Stress Incontinence, and if exercises fail to improve the condition, Sling Surgery may be an option. The procedure involves inserting a ‘sling’ (either artificial or created from the patient’s own tissue) to assist with the support of the urethra, usually managed by the pelvic floor muscle.

Part of a Sling procedure may include the insertion of an artificial sphincter. A sphincter is a circular muscle that keeps a tube in the body closed until its relaxed to open. Although this requires the person to then manually release the sphincter by applying pressure to a device underneath the skin, success in restoring control is typically excellent. You can read more about this procedure on the Australian Urology Associates website.

Augmenting the bladder (make it bigger) to relieve an overactive bladder that’s causing urge incontinence is a rare approach as retraining and medication are usually effective treatments. However, if surgery is deemed appropriate, it involves sewing a ‘patch’ of tissue taken from the bowel or stomach into the bladder to make it larger.

Post-operative incontinence
Read more about Prostate Cancer and Male Urinary Incontinence in this TENA article.

Essential questions to ask if you’re contemplating surgery

• What are the non-surgical options?
  Aside from the general risks mentioned in the above (infection, bleeding, etc.) insist that you understand all of the possible outcomes. Degrees of erectile dysfunction can be an issue following radical prostatectomy (removal of the prostate). You can read more about that on this John Hopkins School of Medicine page.
• What are the non-surgical options?
  Before committing to surgery, check with your doctor that all conservative (non-invasive) options have been explored. Operations shouldn’t be viewed as a quick and easy fix.
• How effective will surgery be?
  Surgery won’t always completely fix the problem. For example, if you suffer from Mixed Incontinence which, as the name suggests, involves both stress and urge incontinence, Sling Surgery may correct the stress aspect, but not the urge. In addition, some men still experience some leakage after this procedure. Discuss success rates and what outcome you can expect with your doctor.
• What to expect?
  Ask to be stepped through precisely what’s going to happen if you proceed with the operation. Do you need to undertake pre-operation preparation, when do you meet with the anaesthetist, do you have other health issues that need to be taken into account, how long will you be in the hospital, will you need a catheter after surgery, how long is the recovery, when can you go back to work?
• How much will it cost?
  Make sure you understand all the costs involved, what’s covered by Medicare (Australia) or your PHO (New Zealand) and how much you’ll be out of pocket. Ask if you’ll need physiotherapy or other allied health services after the operation and how much that costs.

The Australian Government website, HealthDirect has a general list of questions to ask before any type of surgery, which may be helpful. Surgery is a big decision, and for some men, it has been positively life-changing. Just make sure that if you are considering it, you have everything you need to make an informed decision.

Sources:
https://prostate-cancer.canceraustralia.gov.au/treatment
https://aua.com.au/urological-conditions-and-our-expertise/general-urology/incontinence/male-urinary-incontinence/male-sling-surgery/
http://urology.jhu.edu/erectileDysfunction/erectile_dysfunctions_RP.php
https://my.clevelandclinic.org/health/treatments/14330-male-sling-procedure
https://www.healthdirect.gov.au/questions-to-ask-before-surgery

Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.