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Controling urinary incontinence

As a man ages, the prostate typically becomes enlarged. This enlarged gland may squeeze the urethra and irritate the bladder, causing urinary problems. "Men with an enlarged prostate may have many of the same symptoms of an overactive bladder," says Benson, "with urgency, frequency, and urge incontinence."

An FDA approved the device, the AMS 800 Urinary Control System made by American Medical Systems Inc. of Minnetonka, Minn., for men who have stress urinary incontinence due to weakness of the sphincter muscles after prostate surgery. It consists of three parts connected by tubing, all surgically implanted: a fluid-filled synthetic cuff that surrounds the urethra, a pump placed in the scrotum, and a balloon reservoir implanted in the abdomen. To urinate, the man squeezes the pump in the scrotum. This action causes fluid to drain from the cuff into the reservoir, which opens the urethra and allows urine to pass. The cuff automatically refills 90 seconds later, closing the urethra.

Prostate cancer and its treatment increase the likelihood of urinary problems. Those who have had the whole prostate gland removed (radical prostatectomy) represent "probably the largest group of men who have urinary incontinence," says Judd W. Moul, M.D., professor and chief of urologic surgery at Duke University in Durham, N.C.

Ray Walsh is one of them. After a radical prostatectomy in 1999, "I leaked the day after my operation and continued to leak for years," says the 70-year-old Annandale, Va., resident. "It was aggravating to walk around wet all the time."
Walsh says the device gave him "great improvement," at first. "I used 10 to 12 pads a day," says Walsh. "When they put the artificial sphincter in, it cut it down to one to two pads." But several years later, when he started having more leakage, Walsh's doctor gave him some disturbing news. "The cuff cut off some of the blood supply and the flesh under the cuff is atrophied to some degree," he says. "I'm not getting as good closure by the cuff."

Choosing a Treatment
Experts agree that no treatment is perfect for everyone with incontinence. Treatment depends not only on the type and severity of incontinence, but on an individual's lifestyle and personal preferences.
Some people are satisfied with the improvement that conservative measures give them. About 70 percent of women with incontinence problems are helped by a combination of simple measures such as bladder retraining, exercises, and medication, says Dmochowski, who specializes in treating women's urology problems. Moul, who treats men, says a combination of pads, medications, and exercise is effective for many men with incontinence problems.