subject: Surgery For Incontinence - The Artificial Urinary Sphincter [print this page] In men, surgery for incontinence can be necessary because of any disease or injury that damages the nerves and this can occur at any age. However, those most likely to be affected are those who have had prostate disease, a stroke, Parkinson's disease, multiple sclerosis or long-term diabetes.
Incontinence is often seen in men who have prostate problems. Encircling the urethra just below the bladder, the main function of this gland is to produce the liquid part of the semen.
As a man grows older, it can become enlarged causing pressure on the urethra and affecting the control of urination. This enlargement can sometimes be caused by cancer which, in some cases, can involve quite radical surgery. Control of the bladder can be impaired following the operation, requiring the use of incontinence pads but, for most men, this will improve within a few months.
However, for some, the lack of bladder control can be so severe that just standing up can cause a large flood of urine to be expelled. This type of incontinence is beyond the capabilities of the various pads, clamps and other commercially-available aids, so a more effective treatment for incontinence needs to be found.
An appointment with a specialist will necessitate the insertion of a probe into the urethra to ascertain the ability of the bladder to retain urine, as well as assessing the condition of the sphincter muscle.
A gravity test will be performed and surgery for incontinence may be necessary, if the sphincter is not strong enough to retain the urine.
There are three surgical treatments for incontinence - a sling, a urinary diversion, or an artificial urinary sphincter.
The sling involves creating a support for the urethra by wrapping a strip of material around it, then attaching the ends of the fabric to the pelvic bones. By keeping constant pressure on the urethra, it is unable to open unless the patient consciously releases the urine.
A urinary diversion is utilised if all bladder function has been lost due to nerve damage or if the bladder itself needs to be removed. The surgeon creates a reservoir from a piece of the small intestine and directs the ureters towards it. He then makes an outlet (or stoma) in the abdomen to allow a catheter to drain the urine into an external bag.
The artificial urinary sphincter consists of a cuff, which is fitted around the urethra and when this is in place, it inflates to squeeze the urethra closed.
Connected to the cuff is a balloon which is inserted into the abdomen underneath the rectus muscle. It is all controlled using a push-button pump, which is pushed into the scrotum. Once all the tubes are connected together and everything is tucked in, the patient is now able to turn his water on and off with the flick of a switch.
