Surgery for prostate cancer or benign prostate enlargement leads to urinary incontinence in a minority of men. This is due to damage to the sphincter muscle surrounding the urethra. The sphincter muscle is located just below the prostate gland.
If there is still bothersome urinary leakage 12 months following prostate surgery then corrective surgery to improve continence can be performed. For cases of mild to moderate incontinence then placement of a sub-urethral sling usually corrects the leakage. The sling is a 20cm by 1cm segment of mesh which is tunnelled into position below the urethral sphincter elevating and compressing it.
For more severe incontinence placement of an artificial urinary sphincter may be required. An artificial urinary sphincter is a pump activated silicone cuff which fits around the urethra compressing it & preventing leakage of urine. Activation of the pump temporarily deflates the silicone cuff thus allowing voiding.
A general anaesthetic is administered. Surgery is performed through a perineal incision (the perineum is the area between the scrotum and anus) so the patients legs are supported by stirrups during surgery. Flexible cystoscopy is used to assess the urethra and sphincter then a catheter is inserted and a 5cm incision made in the perineum. The urethra is identified. The sling is tunnelled around the pubic bones on each side then tensioned which leads to urethral elevation and compression. Dissolving sutures are used to close the wound.
The urethral catheter is removed the following morning. Once normal voiding is resumed then you may head home. Occasionally a man may not be able to void following catheter removal in which case the catheter in re-inserted and left in place for several more days. Eventually voiding resumes.
A flexible cystoscopy will be performed to evaluate the urethra, sphincter, bladder neck and bladder.
Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications.
A urine sample needs to be provided to the laboratory 1 week prior to surgery.
Over a period of several months the tissues of the body will grow into the pores of the mesh thereby firmly anchoring the mesh into position. During this period it is important not to engage in strenuous activity which may lead to sling loosening. Activities to avoid include those where the legs are spread widely apart, squatting down and stepping up onto high surfaces (such as when getting into a truck).
There may be some temporary perineal numbness. This is due to nerve injury & usually resolves within several months.
Return to work
Most men will be able to return to sedentary work after 3 weeks.
I will see you three months following surgery to assess your recovery and the result of surgery.
Risks recognised as common or serious are listed below but this does not include the rare and extraordinary
- Bleeding requiring transfusion < 5%
- Persistent urinary retention may require a second procedure to loosen the sling. This is rare.
- Mesh infection - rare
- Persistence of incontinence - if this occurs then an artificial urinary sphincter may need to be used. Previous sling surgery does not prevent implantation of an artificial urinary sphincter
- Chronic pain - rare