Urinary incontinence post-prostatectomy is a too common complaint from men. Although the actual degree of incontinence suffered ranges from being minor, or a simple and small amount of post urination dribble, to a complete and total inability to control any urine flow, the most bothersome issues that significantly affects a man’s quality of life (QoL) is when the incontinence is at the extreme.
Currently, we have two methods add to urinary control in those men who suffer the most, those with minimal or no urinary control. These methods include the surgical implantation of a “Male Sling” or the surgical implantation of an Artificial Urinary Sphincter (AUS).
Both of these methods involve significant and invasive surgical intervention. Neither of the methods are 100% effective. Both come with the potential of significant side effects that need to be disclosed to patients.
In a study of the risks of perioperative complications from an AUS implantation for post-prostatectomy incontinence the researchers observed an overall risk of perioperative complications at a 35% rate. The major side effect risk was urinary retention. In addition, the researchers found that men suffering from perioperative urinary retention had significantly less favorable 5-year device survival than those not suffering from urinary retention.
Several important lessons were learned from this research. Early postoperative monitoring of an individual’s voiding ability after implantation is vital. Catheter use may be inevitable in a large proportion of men, but strategic approaches (small-caliber catheters, intermittent and brief insertions) with a low threshold for suprapubic catheterization can be implemented in hopes of reducing complication risks.
Men considering this option need to be told by their doctor that there is such a high rate of AUS failure. Doctors also need to develop better methods to reduce the likelihood of urinary retention and they must pay better attention to their patients in order to minimize the potential risks.