Urinary incontinence is a common problem suffered by many of us post both surgery and radiation therapy for prostate cancer. The degree of incontinence varies from no problem all the way to having no control of the urinary function. Men having surgery find that as time progresses post treatment, they do regain levels of urinary control, but some of us never gain back control. Those of us who have had radiation find they might actually lose control (or degrees of control) as time progresses. No matter which treatment modality we choose, the potential for urinary incontinence stares us in the face.

When the incontinence becomes uncontrollable by exercise and pads, you might consider a surgical remedy. There are a number of surgical interventions available, including the surgical installation of an artificial urinary sphincter (AUS) and the insertion of an adjustable bulbourethral male sling.

At the Department of Urology, S. B. Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey there was a very small study conducted to compare the efficacy of these two procedures.

Sixteen patients with recurrent post-prostatectomy incontinence (no radiation patients in this study) who had undergone either adjustable bulbourethral male sling placement (group 1, n = 8 ) or AUS implantation (group 2, n = 8 ) were included in the study. The preoperative evaluations included history, physical examination, International Consultation on Incontinence Questionnaire-short form, pad test, cystoscopy, and urodynamic studies. The follow-up examinations were performed at 1, 3, 6, and 12 months post-operatively and annually thereafter.

The mean follow-up was 10 months (range 7-19) and 22 months (range 6-38) for groups 1 and 2, respectively (P = .009). Of the 16 patients, 6 were cured, 1 with the sling and 5 with the AUS (cure was defined as no pads daily); 3 were improved, 1 with the sling and 2 with the AUS (improvement was defined as no more than 2 pads daily), and 7 had treatment failure, 6 with the sling and 1 with the AUS. No intraoperative complication was seen in either group. Readjustment of sling tension was done in 4 patients who had persistent incontinence. No re-operation, excluding the readjustments, was required in group 1; however, 3 patients had transient perineal pain. The AUS was removed for recent erosion at 6 and 12 months post-operatively in 1 cured patient and 1 patient with treatment failure, respectively. Ultimately, 50% of the patients (25% with the sling and 75% with the AUS) were cured or improved.

The results of this study have shown that AUS implantation results in better outcomes than placement of the adjustable bulbourethral male sling as secondary therapy.

Reference: Tuygun C, Imamoglu A, Gucuk A, Goktug G, Demirel F.,
Urology. 2009 Apr 17. Epub ahead of print.
doi: 10.1016/j.urology.2008.10.073

PubMed Abstract: 19376562

Joel T Nowak MA, MSW