Urinary Incontinence : Prostate, Treatment

by Food and Drug Administration (FDA)

(Page 4 of 4)

Prostate-Related Incontinence

As a man ages, the prostate typically becomes enlarged. This enlarged gland may squeeze the urethra and irritate the bladder, causing urinary problems. "Men with an enlarged prostate may have many of the same symptoms of an overactive bladder," says Benson, "with urgency, frequency, and urge incontinence."

Prostate cancer and its treatment increase the likelihood of urinary problems. Those who have had the whole prostate gland removed (radical prostatectomy) represent "probably the largest group of men who have urinary incontinence," says Judd W. Moul, M.D., professor and chief of urologic surgery at Duke University in Durham, N.C.

Increased public awareness and screening are leading to earlier treatment for prostate cancer, says Moul, "so the good news is the cure rates are going up, and the other good news is the risk of incontinence is getting less." Yet, up to 20 percent of men treated for prostate cancer have stress incontinence, he says.

Ray Walsh is one of them. After a radical prostatectomy in 1999, "I leaked the day after my operation and continued to leak for years," says the 70-year-old Annandale, Va., resident. "It was aggravating to walk around wet all the time."

Walsh tried an array of treatments — bladder retraining, Kegel exercises with biofeedback, medication, behavioral modification, and the InterStim — with no significant improvement. So in 2001, he had an "artificial sphincter" implanted.

The FDA approved the device, the AMS 800 Urinary Control System made by American Medical Systems Inc. of Minnetonka, Minn., for men who have stress urinary incontinence due to weakness of the sphincter muscles after prostate surgery. It consists of three parts connected by tubing, all surgically implanted: a fluid-filled synthetic cuff that surrounds the urethra, a pump placed in the scrotum, and a balloon reservoir implanted in the abdomen. To urinate, the man squeezes the pump in the scrotum. This action causes fluid to drain from the cuff into the reservoir, which opens the urethra and allows urine to pass. The cuff automatically refills 90 seconds later, closing the urethra.

Walsh says the device gave him "great improvement," at first. "I used 10 to 12 pads a day," says Walsh. "When they put the artificial sphincter in, it cut it down to one to two pads." But several years later, when he started having more leakage, Walsh's doctor gave him some disturbing news. "The cuff cut off some of the blood supply and the flesh under the cuff is atrophied to some degree," he says. "I'm not getting as good closure by the cuff."

Walsh is now considering another surgery to get a second cuff to assist the first one. "The downside of that," he says, "is that the flesh between the two cuffs can atrophy because the blood supply is cut off from both sides." In the meantime, Walsh is taking a bladder-relaxant medication, which is giving him "a little more control," he says. "I'm just destined — until I put that second cuff in — to using three to four pads per day."

Choosing a Treatment

Experts agree that no treatment is perfect for everyone with incontinence. Treatment depends not only on the type and severity of incontinence, but on an individual's lifestyle and personal preferences.

And the success of treatment is an individual perception, says Leng. "Some patients with stress incontinence and active lifestyles expect that 'success' means no more pads. On the other hand, some patients with severe incontinence of a complex nature who have failed multiple treatment options may be thrilled with 50 percent improvement of their bladder control."

"It may not always be a reasonable expectation to be cured," adds Dmochowski. "We try to focus on improvement rate."

Some people are satisfied with the improvement that conservative measures give them. About 70 percent of women with incontinence problems are helped by a combination of simple measures such as bladder retraining, exercises, and medication, says Dmochowski, who specializes in treating women's urology problems. Moul, who treats men, says a combination of pads, medications, and exercise is effective for many men with incontinence problems.

Although Dmochowski thinks of surgery as a last resort, not all of his patients do, he says. "Some younger women with pure stress incontinence ... are desirous of a one-step procedure, and surgery often provides that. It's an individual choice."

In any case, says Dmochowski, "people should look at the degree of their problem and their quality of life, seek a consultation, be aware of all the options, and actively participate in the decision process."

About the Author

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