Urinary Incontinence

Male Artificial Urinary Sphincter

Urinary incontinence is a problem for men and women. It is caused by failure of the urinary sphincter, the muscle that controls your ability to hold your pee. This is common after treatment for prostate cancer, such as surgical removal of the prostate or radiation therapy. An Artificial Urinary Sphincter (AUS) can be used to stop this leakage of urine.

The device is implanted surgically, and is composed of 3 main parts:

  • Urethral cuff: inflatable device that fits around the urethra. It is filled with fluid, and when closed, compresses the urethra to stop urine from flowing.
  • Pump: a device that sits in the scrotum which allows to inflate and deflate the cuff.
  • Balloon: holds the fluid, and allows it to move in and out of the cuff to either activate or deactivate the device. This balloon sits behind the abdominal muscles.

How it Works

In order to void, you will squeeze the pump, which is located in your scrotum. This will move fluid from the cuff to the balloon. The urethra will then be open and urine can easily pass. The cuff stays open for about 3 minutes, at which point it will close automatically.

Risks of the Procedure

  • Infection
  • Pain
  • Bleeding
  • Device failure or break down
  • Injury to the urethra
  • Continued leakage of urine
  • Injury to other organs in the area
  • Urinary tract infections or other bladder issues

After the Procedure

You will be in hospital overnight with a urinary or foley catheter draining your bladder. You will receive antibiotics as well as pain medication and fluids.

Your catheter will be removed before you go home.

Post-Surgical Discharge

  • The device will be DEACTIVATED, and you will therefore still have leakage of urine. This is normal.
  • You will be discharged with antibiotics medication as well as pain management and a stool softener.
  • You may shower when you get home. No baths, hot tubs, or swimming for 2 weeks.
  • No heavy lifting/straining/strenuous activities for 6 weeks
  • You will see your urologist for activation approximately 6-8 weeks after surgery. You will be taught how to use the device at your follow up appointment.

Important

Other medical professionals need to know that you have an AUS. Please order a MedicAlert bracelet or necklace.

More Information

Please visit BC HealthLink for more information.

The following video may also be informative.

Female Stress Urinary Incontinence

Stress urinary incontinence (SUI) is the involuntary loss of urine with straining or activity. You may find that you leak with coughing, sneezing, laughing, or exercise. This type of incontinence is caused by weakening of the muscles that support the urethra and bladder. Common causes of this weakening include age, childbirth, trauma, or hormone changes.

There are many different options to treat stress urinary incontinence.

  1. Do nothing. Urinary incontinence is not life threatening. You do not need management for it if you are not bothered.
  2. Pelvic floor physiotherapy/pelvic floor muscle training. A physiotherapist will teach you some exercises to try and strengthen the muscles of the pelvic floor.
  3. A pessary. This is a device that is inserted into the vagina and applies pressure to the base of the bladder and urethra to try and prevent leakage.
  4. Some patients will find some mild benefit from a medication called duloxetine. This is an anti-depressant medication, however in smaller doses it can help some patients with SUI.
  5. Urethral bulking agents. This is a medication which is injected under the lining of the urethra to try to “bulk” it up to prevent urine leakage.
  6. Midurethral sling. This is a mesh device that is placed under the urethra to recreate the structural support of the muscles of the pelvis. It is the most common surgical procedure performed for SUI.
  7. Fascial sling. This is very similar to the Midurethral sling, however instead of mesh, we use fascia, which is from your own body.
  8. Burch colposuspension. This is a surgery performed by the gynecologists, which raises the sides of the vagina to try and support the bladder and urethra.

The most common surgical procedure we perform is the midurethral sling.

Procedure:

  • This is a day procedure. You will go home after your surgery.
  • You will go to sleep with the anesthetist for the operation.
  • A small incision is made in the front of the vagina as well as two tiny incisions just above your pubic bone, below your bikini line.
  • A device is used to pass the mesh under the urethra and behind the pubic bone.
  • Once the mesh is correctly positioned, we close the incisions with dissolving stitches.
  • The procedure takes about 30 minutes.

There are a few risks to consider:

  • Pain in the vagina or pelvis
  • Pain during intercourse
  • Difficulty emptying your bladder
  • Urinary tract infections
  • Skin infection
  • Erosion of the mesh. This occurs when the mesh migrates to other parts of the pelvis, such as in the urethra, bladder, or vagina.
  • Bleeding or bruising after the procedure.

After the procedure:

  • We will make sure that you can void after the procedure before you go home.
  • You will be discharged with antibiotics as well as medication for pain and a stool softener.
  • You may shower when you get home.
  • No Baths, hot tubs, or swimming pools for two (2) weeks
  • ABSOLUTELY NO HEAVY LIFTING OR STRAINING FOR SIX (6) WEEKS.
    • Do not lift anything heavier than 10 lbs
  • Nothing in the vagina for six (6) weeks.

Patient Information:

Please download Boston Scientific's pamphlet on Female Stress Urinary Incontinence for additional information here.