BLADDER CONTROL PROBLEMS FOR MEN

FREQUENTLY ASKED QUESTIONS

At first a patient may feel embarrassed talking to a doctor about bladder control problems, but it is important to know that thousand of men have sought help for this condition.  Once the condition is revealed, the family doctor or internist will probably refer the patient to an urologist who specializes in the treatment of urinary incontinence.  Together, the urologist and the patient can discuss the treatment options and decide which one is best.

What can the urologist do for the patient?

The experienced urologist will determine whether the urinary leakage is related to the urinary bladder (overactive or inactive), or the sphincter (most commonly damaged during external beam radiation or removal of the prostate gland for prostate cancer or a neurologic condition).  In select cases, both the urinary bladder and the sphincter can malfunction.  Urodynamic evaluation and cystoscopy are of paramount importance as diagnostic tools in such cases.  Patients with urinary incontinence related to bladder dysfunction may be candidates for InterStim Therapy or experimental Botulinum-Toxin injection.  Patients with urinary sphincter problems may benefit from an "implantable artificial urinary sphincter (AUS)" or a "bulbar sling" procedure, in which tissue is placed to compress the urethra tube.  The tissue may be secured to bone anchors.  In most cases, the physician may prefer the AUS because it allows for a more natural voiding pattern.

What is an implantable prosthesis?

The artificial urinary sphincter (AUS) prosthesis, used successfully since the early 1970's, is a small, implantable silicone device.  It is implanted entirely within the body and works by moving fluid in and out of three main components: the bulbar cuff that remains inflated when the bladder fills, artificially replacing the native damaged sphincter, and provides continence; the scrotal pump which allows deflation of the cuff when urination is desired: and the reservoir which stores the fluid which is being shifted back and forth during cuff inflation and deflation.  The following figures illustrate device function.

The cuff is filled with fluid and gently squeezes the urethra closed to keep urine in the bladder.

Squeeze and release the pump (located in the scrotum) to open the cuff.  When the empty cuff is no longer pressing the urethra closed, urine can flow out of the bladder.

Several minutes after the bladder is empty the fluid automatically returns from the balloon (located in the abdomen) to the cuff.  The urethra is squeezed closed again.