Long-term Severe Incontinence

It must be emphasised that severe long-term incontinence is rare, and nearly all men recover continence after treatment within months. So do not despair.

Note: This section only applies to men who experience serious
long-term incontinence problems that severely affect quality of life.

The sphincter is a natural on/off valve associated with the urethra, which can become weakened or even damaged, usually during prostate surgery. In nearly all cases nowadays this strengthens over time (often with the help of pelvic floor exercises) (see Problems with Continence), and men usually gain full continence after 3–6 months or less.

In up to 3% of cases, however, this can remain a problem after a year. If this is the case, there are two methods which are now used – a male sling (an implant for mild to moderate incontinence) and an operation to fit an artificial sphincter (for more severe cases).

The sling

The sling is made from polypropylene mesh and is implanted during a small operation, under general anaesthetic, through a small incision in the perineal area. It acts as a support for the urethra. A catheter may be needed for a short period, but normal urination should gradually be restored after this is removed. 

The artificial sphincter

There are two parts to fitting an artificial urinary sphincter (AUS), an operation done under full anaesthetic: the fitting of the sphincter, a cuff around the urethra, and an incision (like a hernia operation) in the groin to fit a pump in the scrotum attached to a small balloon. When the need to urinate is felt, a switch is pressed in the scrotum, which releases the urine, and after a few minutes the device self-closes.

After the operation, the device cannot be used for six weeks, when it is activated by the nurse. Thereafter it alleviates the problem considerably.