Male urinary incontinence surgery

Stress urinary incontinence, i.e., uncontrolled loss of urine in conjunction with increased pressure inside the abdomen such as coughing, sneezing, moving from a lying position to an upright posture, in the male patient is almost exclusively a consequence of surgery performed in the anatomical region of the pelvis on the prostate and / or bladder. The first approach that can be proposed is always a conservative one. In this context, the patient is instructed by an expert physiotherapist to perform a specific pelvic gymnastics aimed at autonomously controlling urinary leakage (also with the help of electrical stimulation of the perineum through specific endorectal probes), possibly accompanied by specific medical therapy with drugs with direct relaxing action on the bladder (also to reduce the frequency of daytime and nighttime urination) or drugs that can support the restraining action of the urethral sphincter and thus reduce the loss of urine. In cases of urinary incontinence not responsive to conservative therapy of the first level, the possibility of corrective surgery can be considered, with the application of various devices, from silicone balloons at the bladder neck to a real artificial urinary sphincter. The choice of therapy depends on the extent of incontinence and  characteristics of the patient.

The two most common types of interventions for the correction of stress incontinence in men are: in cases of mild-moderate incontinence, the placement of a small bender (or sling) of biocompatible material, at the suburethral level, and, in cases of severe incontinence, the placement of a real urinary prosthesis: the artificial sphincter. The latter has the purpose of mechanically compressing the urethra in order to stop urine leakage. Both procedures involve a perineal approach (in the region between the scrotum and the anus). In the first case, three small incisions are made, one perineal and two inguinal, through which the sling is positioned and the urethra is lifted in order to support increases in abdominal pressure and thus counteract leakage. In the second case, however, in addition to the incision at scroital level, another incision at abdominal level will allow to insert the urinary prosthesis consisting of three components: a reservoir, a cuff (which will be placed around the urethra), and a pump (which will be placed inside the scrotum). Both procedures are, in most cases, performed under spinal anesthesia.