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Urinary incontinence in men – Artificial sphincter – The permanent solution

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Urinary incontinence in men is rarer than in women. Its frequency ranges between 12-17% in men and is divided intoThus, the urge incontinence with a non neurological cause can be usually observed in older men and is principally due to the obstruction of the outflow of the urine, due to prostatic hyperplasia. More rarely, it can be due to a tumor or stone of the urinary bladder. In younger men it is very rare, and if it suddenly occurs, the patient should be examined for some emerging neurological disease, usually multiple sclerosis.

 

Η ανατομία της περιοχής του έξω σφιγκτήρα της ουρήθρας. Είναι φανερό, ότι σε ριζική αφαίρεση του προστάτη, η πιθανότητα κάκωσης του σφιγκτήρα μπορεί να είναι αναπόφευκτη, ώστε να εξασφαλισθεί η πλήρης απαλλαγή από τον καρκίνοHowever, the milder type of an overactive bladder, of which the stronger clinical form is the urge incontinence, is frequent urination. This phenomenon is also very frequently observed in younger men, usually due to chronic prostatitis. Overflow incontinence is sometimes observed in men with severe obstruction of the urine outflow, which is usually due to a prostatic hyperplasia. The stress urinary incontinence in men, in contrast with women, is always due to the weakness of the external mechanism of the urethral sphincter, which surrounds anatomically the section of the urethra which is located on top of the prostate. The sphincter weakness is more rarely due to neurological damages, and is usually due to surgical operations. The radical prostatectomy for the treatment of prostate cancer is the most common operation that causes stress incontinence and its frequency ranges in various studies between 2%- 43%. Practically, experience shows that approximately 10% of the patients who undergo any kind of radical prostatectomy will have, 12 months after the operation, a very disturbing urinary incontinence. If we also consider that prostate cancer is the most common cancer in men, and 45 new cases out of 1000 men who are 60 years old occur per year, and that one out of six men will present prostate cancer during his lifetime, we can understand how serious the problem is. The transurethral prostatectomy for the benign prostatic hyperplasia is also relate, at a percentage of 1%-3%, with urinary incontinence. Finally, both the external and the internal radiotherapy for prostate cancer are accompanied by urinary incontinence in 1%-16% of the cases.

 

Urinary incontinence in men, as in women, is not a life or health threatening disease for the patient. However, it can create a serious life quality problem, with psychological effects that sometimes lead to depression. Furthermore, it is accompanied by a high cost for the purchase of incontinence diapers. Finally, due to the permanent maceration of the genital area by urine, dermatitis and mycoses are generated, which are very disturbing and difficultly treatable. Of course, if the incontinence is due to an underlying disease, the symptoms of this underlying disease coexist. For example, urinary hesitation in cases of prostatic hyperplasia.
 


 

Diagnostically and therapeutically the treatment of male urinary incontinence must be performed by the specialized urologist. In the case of urge incontinence must be controlled the possible presence of an underlying disease, the treatment of which will improve or even resolve the problem. If an underlying disease cannot be found or if its treatment did not improve the incontinence, there are medicines that can be used. In the case of overflow incontinence the obstruction must be treated, for example with an operation in case of benign prostatic hyperplasia.

The problem the specialized urologist can really help resolving, is the urinary incontinence after prostatectomy and more usually after radical prostatectomy, for the treatment of prostate cancer, as it has been mentioned before. We recommend to our patient to wait for one year after the operation, because up to then the operated tissues are still recovering and the incontinence can disappear or significantly improve and it cannot eventually disturb the patient. If this does not happen, we will examine our patient with specific special urological tests and we will propose to him the surgical treatment for his incontinence.

 

Γραφική παράσταση των τριών τμημάτων του σφιγκτήρα τοποθετημένων στην ανατομική τους θέση. Όλη η επέμβαση γίνεται με μία τομή στη βάση του πέουςThere are various ways to treat the urinary incontinence in men which is due to the weakness of the sphincter, and their selection is made by specialized doctors. They all include the placement of protheses. The most effective way is the placement of an artificial sphincter. This treatment is globally characterized as the “gold standard”, and the effectiveness of all other types of surgical treatment of incontinence are compared to it. The artificial phincter is a silicone implant that consists of three sections and its function is purely hydraulic. The material is always accepted by the human organism. These sections are the cuff which is placed around the urethra, the pump and the water reservoir.The placement of the entire device is performed today through an incision that is made on the base of the penis., which is a better technique than the classical placement with two incisions.

 

According to the European Association of Urology, the effectiveness of the artificial sphincter is up to 60%-90%, depending on the studies, and it is the highest compared to any other operation for the treatment of incontinence after prostatectomy. The frequency of complication ranges between 4.5%-15% and in 25% of the cases the replacement of the artificial sphincter will be necessary at some point. However, the cost of the material that is going to be used in case of replacement is covered by a lifetime guarantee and is absolutely free. The National Health Insurance Fund (EOPYY) covers 90% of the cost of the material, after an approval is granded after the examination of the necessary supporting documents. The replacement, if necessary is a simple procedure in the hands of an experienced urologist.