Our Services

Incontinence Treatment

There are a number of types of incontinence (leaking of urine) and this determines the type of treatment needed.  Urge urinary incontinence is having the sense of needing to urinate and not making it to the bathroom in time.  This type of incontinence tends to be associated with neurologic disorders, diabetes or the result of an enlarged bladder for a prolonged time.  A separate type of incontinence is male stress urinary incontinence (SUI).  This incontinence is leaking urine with cough, sneeze, laugh, lifting or any movement that can increase abdominal pressure.  Male stress urinary incontinence occurs in around 4-40% of men following prostate cancer treatments.  Men may have mixed incontinence with features of both as well.  Following some prostate treatments or spinal cord injuries, men may experience total incontinence, with leaking of urine all the time and very little to no control of the leakage.  

All types of urinary incontinence are associated with decreased quality of life and significant bother for patients.  Men may have severe incontinence requiring Depends or multiple pads per day, or the incontinence may be minor requiring only changing clothes intermittently.  Treatments need to be directed at the underlying cause and with a clear focus on the type of incontinence that is predominant.  

Stress urinary incontinence is a potential side effect following prostatectomy.  Many men experience incontinence initially following surgical removal of the prostate, but most men regain control over the first 6 months.   Stress urinary incontinence is not normal for men.   Therapy like Kegel exercises can improve and speed recovery of continence.  This is more successful when performed with biofeedback or a physical therapist.  Approximately 4% of men will have significant stress urinary incontinence that leads them to seek a cure.  A larger percentage of men will have stress incontinence that is either not bothersome (usually 1-2 pad per day or less) or they are unaware options exist to improve their continence.   Men who undergo radiation therapy or brachytherapy (seed placement) followed by surgical removal of the prostate often have stress incontinence or total incontinence due to their treatments.  Total incontinence can be seen rarely following transurethral resection of the prostate (TURP) as well.  Even in the most severe cases, therapy exists that can help the patient regain control.  

When a patient comes in for an appointment to discuss urinary incontinence, they can expect the initial step to be an assessment of their history and medication that may be associated with incontinence.  Often a post-void residual (PVR) will be obtained and a urinalysis.  This is simply having a patient empty their bladder and then using a non-invasive ultrasound measuring the amount of fluid left in the bladder.   Initial attempts to control incontinence may involve medication, but stress incontinence and total incontinence rarely respond well to medication.  There are several tests that can be performed that may clarify the causes and type of incontinence as well.

  • Cystoscopy- a small camera is carefully passed along the urethra (urinary channel) and into the bladder.  This can provide useful information on the anatomy of the bladder, potential for scar tissue in the urethra, and ensure there are no bladder tumors or stones that may be contributing to the leakage.  Often during this process, if considering a male sling, we will ask the patient to close their sphincter muscle to ensure the sphincter does coapt (bring the sides together) well.  
  • Urodynamics- this is a test where very small catheters are placed in the bladder and the rectum to measure pressure as the bladder fills.  The bladder catheter will help fill the bladder with fluid and measure for bladder wall contraction which may be felt as an urge to urinate to the patient.  Urodynamics can also ensure the patient’s bladder is able to generate a normal contraction to expel the urine, an aspect that is potentially important in some male sling cases.  

 

Urge incontinence

Urge incontinence is leakage that is associated with the sudden onset or need to urinate.  

Causes of urge incontinence include:

  • Diabetes
  • BPH or enlarged prostate
  • Spinal cord injury or trauma
  • Nerve injury, at times associated with back injuries
  • Bladder stones

Treatments for urge incontinence include:

  1. Bladder Botox injections
    1. Through a cystoscopy, botox is delivered into the bladder wall
    2. This helps decrease the sensation of the bladder which can allow the patient to store more urine and obtain more warning before the need to urinate
    3. Side effects of botox include possible urinary retention or difficulty urinating, bleeding and a need for repeat botox procedures
  2. Interstim placement
    1. A small electrode is inserted in the back to stimulate the sacral nerves, changing how the bladder is sensed
    2. There is initially a test week followed by permanent device placement
      1. This device does have a battery that may need to be replaced in the future
    3. Risks of the procedure include infection, rarely pain in an atypical location or inability to attain an MRI
  3. Posterior Tibial Nerve Stimulation
    1. An in-office procedure where a small needle is inserted around the tibial nerve at the ankle
    2. This provides a 30 minute treatment session once weekly to adapt the nerves sensing the bladder
    3. This has few risks or side effects, but does require frequent visits to the office


Male Stress Urinary Incontinence

Incontinence associated with lifting, standing from a seated position, sneezing, laughing or any activity that causes the abdominal muscles to contract and increase pressure in the abdomen.

This is most commonly seen following removal of the prostate and is known as post-prostatectomy incontinence.   The number of men who end up with post-prostatectomy incontinence depends on the definition of incontinence used.  If less than 2 pads daily is considered continent, a smaller number of men (around 2-4%) have incontinence.  If no pads daily is considered continent, up to 60% of men may have post-prostatectomy incontinence.  If the incontinence bothers a patient, no matter how little the volume of fluid leaking, it is worth discussing potential treatment options.  

  1. Peri-urethral injections
    1. Injection of a bulking agent around the urethra to increase the pressure of the urethra and attempt to minimize leakage
    2. Often requires multiple procedures and only useful to treat very minimal incontinence
  2. Advance Trans-obturator male sling
    1. A two armed sling to reposition the urethra following prostate cancer treatment
    2. Provides a back-stop for the urethra to close with cough, sneeze or activity
    3. Success rates of 54-80% for improvement, around 50% dry
    4. Risks of the procedure include urinary retention, perineal pain, infection, erosion, and recurrent incontinence.
    5. Able to treat mild to moderate incontinence

Virtue male sling - can decrease leaking of urine with stress maneuvers like coughing, laughing, standing or at the time of orgasm. Helps restore continence following prostate surgery.​
  1. Virtue Quadratic sling
    1. A four arm sling to reposition the urethra and provide a compression mechanism to further increase resistance and decrease post-prostatectomy incontinence
    2. Success rates of 70-79% for improvement, around 50% dry as well
    3. Risks of the procedure include urinary retention, perineal or scrotal pain, infection, and recurrent incontinence.  
    4. Able to treat mild to severe incontinence

Artificial urinary sphincter (AUS) restores urine control following prostate cancer treatments.
  1. Artificial urinary sphincter
    1. Internal device that is not seen from outside the body
    2. Creates a new closure of the urethra to minimize incontinence
    3. Opens when a patient squeezes a pump placed in the scrotum
      • This is not painful to perform
    4. Success and cure rates over 80%
    5. Able to treat all levels of incontinence
    6. Risks of the procedure include infection or erosion of the device requiring removal, mechanical failure of the device, urethral atrophy, and recurrent incontinence.
    7. Around 25% of the patients require revision of the device within 10-12 years

 

Multiple factors are important to determine the correct procedure and to maximize benefit.  It is important to realize that no procedure can guarantee a patient will be 100% dry.   Many patients do end up without the need for pads.  Important factors are:

  • Patient factors- many patients will choose a male sling over the artificial urinary sphincter if the chooses appear to have equal chances of success
  • Time following prostatectomy- improvements may be seen naturally over the first 12 months following prostate removal
  • Degree of incontinence
    • This may be quantified by number of pads, pad weight
  • Prior radiation therapy
    • Increases chance of residual incontinence following male sling or artificial urinary sphincter
  • Prior surgery
    • Having a prior artificial sphincter or sling may change the likelihood of success with repeat treatment or attempts at an alternative treatment

 

Total urinary incontinence

Complete loss of urine with little ability to control urine flow.

Typically seen following rare cases of transurethral surgery of the prostate or radiation therapy combined with prostate removal.

This type of incontinence is typically best treated with an artificial urinary sphincter.  Success rates depend on the cause of the incontinence.  

 

Climacturia

This type of incontinence is loss of urine at the time of orgasm.

Not a very common problem but may be seen after prostate removal.

This type of incontinence responds well to physical therapy or considering a male urethral sling.

You don’t have to continue leaking.  There are treatments available and it is not considered normal to have incontinence as men age.  Please schedule a visit with Dr. Lowe to determine which options may be right for you.



OTHER SPECIALTIES AT LOWE UROLOGY

Patient Instructions

Dr. Lowe’s Pre-Operative Instructions for AUS surgery

Questions to ask your surgeon prior to male sling (Virtue, Advance) or Artificial Urinary Sphincter surgery

  1. How many slings or artificial sphincters have you done over the last 3-4 years?  How many do you typically do per year?
  2. What type of device do you think is best for me?
  3. Are there other options I should consider prior to surgery?
  4. What training have you received regarding placement of male slings or artificial sphincters?
  5. Will I need to stay in the hospital overnight?
  6. Will I need to keep a catheter in following surgery?
  7. When should I expect to stop leaking?  Will I be completely dry following surgery (typically we cannot guarantee being completely dry, but important to have a clear expectation)?


AUS= artificial urinary sphincter 

It is important that patients do not eat or drink anything, even coffee or water, starting at midnight the night before artificial urinary sphincter (AUS) surgery. However, all medications can be taken with a sip of water.

Please stay on low dose aspirin prior to surgery.

Please arrive at the surgery center two hours before your scheduled surgery time. If your scheduled surgery time is the first of the day, please arrive at 6:00am.

This procedure can be done safely with one to two small incisions in about one hour and normally requires a 24 hour hospital stay. Incisions will be located just above the penis and over the perineum (figure B), the area between the anus and scrotum. 

Figure-A.png                      B Figure-B.png


For more information, and to see stories of men who have had this treatment, visit www.MaleContinence.com.

Home Care After Surgery

Home Care after Male Sling (Virtue, AdVance)

Follow these guidelines for your care after your surgery to help your recovery. The recovery for this surgery is very important for the success of the procedure.

 

Activity

• Limit your activity for the first 21 days after surgery to light activity.

• You may return to work in a week or so.

• Limit lifting, pushing or pulling to less than 5 pounds for the next 4 weeks.

• Limit any activity that requires your legs to stretch apart, lift knee above waist or squatting. 

You should continue walking when you return home, gradually increasing the amount of walking you do each day. Short frequent walks of 10-15 minutes are a good starting point (at least 3-4 times a day). Walking will help you rebuild strength.

Take planned rest periods during the day. The best gauge is your body and how you feel.

You may walk up and down stairs as soon as you return home, but take them slowly.

Avoid heavy lifting (greater than 5 pounds) or strenuous activity for 4 weeks after you are discharged. Heavy lifting can increase abdominal pressure, which can put a strain on your incision. If you need to brace yourself to pick something up, then it is too heavy. Five pounds is equivalent to a large telephone book or a gallon of milk.

Avoid bending. This is tiring and also increases abdominal pressure. If you must pick something up, bend with your knees (not at your waist).

 

Swelling

Scrotal swelling from the surgery may take weeks to get better. You should call your doctor if the swelling is severe and the scrotum is larger than an orange.

• Use ice packs to the scrotum and penis for 15 minutes every hour for the first 48 hours when you are awake to limit swelling. Use a plastic bag with ice or a bag of frozen peas for the ice pack. Wrap a cloth or towel around the ice pack so the ice does not directly touch your skin.

• Wear a jock strap or tight underwear for the next week to support your scrotum and reduce swelling.

• When swelling decreases after 1-2 weeks, please begin to pull down gently on the pump in the scrotum. Perform the pulling down twice daily. 

 

Incision care

• Stitches will dissolve and do not need to be removed.

• Expect a small amount of blood may stain the dressings for up to 72 hours after surgery.

• For the first few days, apply two or three gauze pads to the site each day and as needed to keep the dressing dry. This will protect the incision and help keep your clothes clean.

• When you are no longer having any drainage, stop using the gauze pads over the site. 

 

Bathing or showering

• You may shower 48 to 72 hours after surgery. Allow the water to wash over the incision but do not scrub the incision. Dry the site gently by patting it with a clean towel.

• Tub baths should be avoided for 14 days after surgery.

• Sitz baths can be used 14 days after surgery to help reduce swelling.

• Swimming or hot tubs should be avoided for 21 days after surgery. 

 

Pain control

You will likely be sent home with a prescription for a few days of pain medicine. Use this only as needed. After 48 hours, most patients can take extra strength Tylenol (acetaminophen) or Advil (ibuprofen) for pain, following the label directions. Pain most often is eased after 5 to 7 days.

 

Sexual activity

Avoid sexual activity for the first 2 weeks after surgery.

 

Follow up

You will need to schedule a follow up visit 4-6 weeks after surgery.

When to call your doctor

Call your surgeon’s office at 614-788-2870 right away if you have:

• Severe swelling, larger than the size of a large orange

• A large amount of fluid drainage that soaks several pads per day

• Pain that is not controlled with pain medicine and use of ice packs or worsens after 48 hours

• Any signs of infection such as: 

• Increased redness or tenderness around the incision site

• Pus type drainage from the incision 

Fever of greater than 101 degrees F

Post-Operative Instructions for AUS surgery

Your will have a glue like material called dermabond over your sutures. Your sutures will dissolve over 2-3 weeks and do not require removal. The dermabond covering the incision will wear off 3-5 days following surgery. 

Keep area around incision clean and dry for 48 hours. After that time, you may shower. Avoid sitting in a tub to bathe for 2 weeks following procedure. Do not scrub your incision when bathing. 

Anti-inflammatories, such as ibuprofen, may be used for post-operative discomfort.

Apply ice over incision 5 times per day, 30 minutes at a time, for 1 week after the procedure.

Ten days after the procedure, please begin to locate the deflate mechanism of the pump in the scrotum, but do not use the device. Begin to gently pull down on the pump mechanism and perform deep tissue massage to the pump area.

Your AUS will remain locked in the open position until your in office follow up with Dr. Lowe so that you are able to urinate. 

Inflation and deflation teaching of the AUS device will be done 4-6 weeks after the procedure.

Please call us if:

  • Your temperature is greater than 101.5
  • Your skin appears very red or hot
  • You have difficulty voiding
 

Dr. Lowe’s Nurse: Julia (614) 788-2878

Dr. Lowe’s MA: Sue (614) 788-2873

Bing office: (614)788-2870

Request An Appointment

Request An Appointment

We will attempt to make the appointment as close to your desired date as possible, but this submission is not a guarantee of an appointment at that time. If an urgent visit is needed to discuss sperm cryopreservation prior to cancer treatment, please call the office directly and be sure to notify the staff of this need.

*All green fields are required

OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center
500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177
 
 

OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center

500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177