What is a urethral sling procedure, and how does it help with urinary incontinence?

In the urethral sling procedure, a synthetic (man-made) mesh tape is placed around part of the urethra, moving the urethra into a new position. This is a minimally invasive procedure, which means that the surgeon only has to make a small incision (cut) in the perineum (the space between the base of the scrotum and the anus).

Your provider may recommend a urethral sling procedure if you have mild to moderate urinary incontinence after a radical prostatectomy that hasn’t improved using other more conservative measures. It's highly successful in helping men overcome incontinence, or reduce episodes of leaking urine.

Before the surgery, the provider may do some tests, including the following:

  • A urodynamic study, to test how well the bladder is working.
  • A 24-hour pad test (to identify how many pads the man uses and how much urine he leaks).
  • A cystoscopy, a test in which the doctor looks inside the bladder with an instrument called a cystoscope.

You don’t have to donate any of your own blood before surgery.

What is an artificial urinary sphincter (AUS), and how does it help with urinary incontinence?

An artificial urinary sphincter (AUS) can help men who have moderate to severe urinary incontinence due to poorly functioning muscle or sphincter valve after prostate cancer surgery.

The AUS has three parts:

  • An inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
  • A pump that is inserted into the scrotum. It's completely on the inside and not visible, and the pump controls the opening and closing of the cuff.
  • A small pressure-regulating balloon (about the size of a Ping-Pong ball) that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.

If you have this surgery, you’ll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When you’re done peeing, the cuff automatically closes again on its own.

The AUS procedure provides a very good and satisfactory result in 90% of cases. Risks are uncommon and include:

  • Failure of the device (usually because of a fluid leak).
  • Erosion of the cuff into the urethra.
  • Infection.

All of these would require additional surgery.

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