Editorial Supplement
Urinary incontinence can affect men after radical prostatectomy, but it usually improves within the first year as control of the sphincter muscle is regained. However, 5% to 10% of men may continue to have a substantial amount of urinary leakage that affects their quality of life enough to make them seek treatment. Among the available options, the AdVanceTM male sling is a simple and effective alternative that has emerged in the past few years.
Early options
To hasten recovery of urinary control within the first year of surgery, Kegel exercises to strengthen the pelvic floor muscles are recommended. If the incontinence persists, many men will seek advice from their urologist. Treatments are designed for urinary leakage that occurs with exertion or in the upright position — called stress incontinence.
One technique used in the past was bulking agents such as collagen, which were injected into the lining of the urethra to restore urinary control — just like a new washer in a leaky tap. While initially promising, this technique did not prove to be durable and is not commonly used today.
The artificial urinary sphincter (AUS), introduced in 1973, has been the most commonly used surgical treatment for incontinence. While the AUS has been successful for men with moderate to severe incontinence (usually requiring four or more pads a day) and those who have undergone radiation, a simpler technology has been developed recently for men with milder stress incontinence (three or fewer pads a day).
The AdVanceTMsling
The AdVanceTM sling is a ribbon of nylon-type mesh that is implanted underneath the urethra and inserted into the region of the pelvic bone. It lifts and supports the urethra to prevent stress incontinence. The surgery takes about an hour and the patient may stay in hospital overnight. While recovery takes a few weeks, heavy lifting and exercise are prohibited for four to six weeks to allow the sling to heal well.
It is important to undergo evaluation by a specialist to make sure the treatment is appropriate. Factors that improve the chances of success with the sling include:
- mild to moderate stress incontinence that persists a year after surgery
- no previous radiation therapy
- no lasting problems with scar tissue in the urethra
One advantage of the sling is that you can still have an AUS later if you’re not completely satisfied.
Patients’ experience
We reported our experience at Sunnybrook Health Sciences Centre with the AdVanceTM sling at the 2010 annual Canadian Urological Association Meeting in Charlottetown, PEI. Our data were based on questionnaires men mailed back an average of 23 months following their sling operation: 37 out of 47 men (79%) stated that they had a substantial improvement in their incontinence; 22 of them (47%) reported that they had no more incontinence. Those who were doing well noted an improvement in their quality of life. No serious problems were seen. The men who had undergone radiation did not fare as well as those who did not.
Ask your doctor
The AdVanceTM sling is available across Canada. Other types of slings and devices are also being developed for stress incontinence after radical prostatectomy.
If incontinence bothers you in the first year after your surgery, ask your family doctor or urologist about Kegel exercises and possibly about seeing a physiotherapist or nurse. For continuing problems, ask about being referred for other types of interventions.
Dr. Sender Herschorn is Professor and Chair of the Division of Urology at the University of Toronto, and attending urologist and Head of Urodynamics Laboratory Sunnybrook Health Sciences Centre. Dr. Herschorn has been a significant contributor to the professional literature on incontinence after radical prostatectomy.
To find out more about theAdVanceTM male sling, visit www.amsadvance.com or call AMS at 1-800-265-2611.
Distribution of this supplement was made possible by an unrestricted educational grant from AMS Canada.
