Incontinence and Erectile Dysfunction - Surgical treatment options
Male sling surgery
The commonest cause of male urinary incontinence is radical prostatectomy for the treatment of prostate cancer. In the vast majority of cases, the involuntary leakage is temporary and minor. However, a proportion of men will continue to have significant leakage of urine in the longer term, impacting on their quality of life. Fortunately, there are highly effective treatment options which include insertion of an artificial urinary sphincter, or a synthetic male sling.
Synthetic male slings are generally recommended for men with mild to moderate degrees of incontinence and there are various types available. Slings are surgically placed under the urethra via a small incision in the perineum (the area of skin between the scrotum and anus). The sling is designed to pull up on the urethra and help the sphincter muscle close more effectively.
Advantages of the male sling include: insertion requires a minor surgical procedure (performed usually as an overnight stay) and that the patient is not required to operate it for the sling to function (unlike the artificial urinary sphincter). The AdVance™ sling is an example that has been in use in Australia for nearly ten years, and A/Prof Moon has published the longest follow-up of any Australian series in 2018 confirming high success rates and low complication rates in men with mild to moderate incontinence after prostatectomy.
Artificial urinary sphincter
The commonest cause of male urinary incontinence is radical prostatectomy for the treatment of prostate cancer. In the vast majority of cases, the involuntary leakage is temporary and minor. However, some men will continue to have significant leakage of urine in the longer term, impacting on their quality of life. Fortunately, there are highly effective treatment options which include insertion of an artificial urinary sphincter, or a synthetic male sling.
The most important component of the urinary continence mechanism is the body's own urethral sphincter, which is a muscle that surrounds the urethra just below the prostate. Although utmost care is taken to prevent injury to this structure during radical prostatectomy, weakening of the sphincter does occur in a proportion of patients, leading to ongoing incontinence.
The artificial urinary sphincter (AUS) is the gold standard of treatment for male urinary incontinence. It has withstood the test of time, being unsurpassed by any other device for decades, and A/Prof Moon has been responsible for publishing the largest Australian experience with this device [1]. The AUS is particularly effective for the more severe type of male urinary incontinence, where circumferential compression of the urethra is required. The AUS can be inserted via one or two small incisions and typically involves an overnight stay in hospital.
The device has 3 main components attached to each other: the cuff (surrounding the urethra), the pump (placed in the scrotum next to one of the testes) and the reservoir (placed in the pelvis). In the normal resting mode, the cuff is full of water, compressing the urethra. When the patient feels his bladder is full, he goes to the toilet and squeezes the pump, which opens the cuff, allowing urine to drain out. Over the next 2-3 minutes the cuff automatically re-fills, closing the urethra again.
1. Sathianathen N, McGuigan S, and Moon D. Outcomes of Artificial Urinary Sphincter Implantation in the Irradiated Patient. BJU Int Apr 2014; 113(4): 636-641
Penile prosthesis
Erectile dysfunction is very common and you should not be afraid to ask for help.
For men suffering erectile dysfunction either as a result of prostate cancer treatment or due to other conditions such as diabetes, there are a number of options available to help restore satisfactory erections.
A/Prof Moon can outline all options and employs dedicated, experienced and empathetic staff to help men trial different methods and choose which is best for them
For definitive treatment a penile prosthesis can be inserted through a minor surgical procedure. Such implants have been used for over 50 years and using a pump hidden discreetly under the scrotal skin, allow an erection to be produced on demand.
A/Prof Moon has over a decade of experience in such procedures and has trained many surgeons in this technique, both in Australia and overseas. He published the largest Australian experience in penile implant surgery in 2017, confirming patient and partner satisfaction rates of 90% with even higher scores for self esteem, confidence and their relationship.