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 (the tube through which urine passes out of the body). This gently and slightly moves 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).

A urethral sling procedure is best suited for men who have mild to moderate urinary incontinence after a radical prostatectomy that is not improved with more conservative measures. It is highly successful in helping patients overcome incontinence, or reduce episodes of leaking urine.

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

  • A urodynamic study, to test how well the urinary tract 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.

The patient does not have to donate any of his 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 patients who have moderate to severe urinary incontinence because they have had significant sphincter muscle or valve damage 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. 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 hold urine back.

When the patient feels the need to urinate, he presses on the pump, which opens the cuff to allow urination. Once the patient is done urinating, the cuff automatically closes again.

The AUS procedure is successful in 90% of cases. Risks are uncommon and include:

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

All of these would require additional surgery.

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