Incontinence After Surgery
Dear OncoLink "Ask The Experts,"
I had a radical prostatectomy about a year ago. The cancer seems to be gone with a serum PSA of zero. I remain incontinent and seem to have control only when I am relaxing, sitting, or not involved in any activity at all. I go through 4 to 6 pads daily. When I am working or otherwise active, I leak constantly. My doctor has suggested implanting an " AMS 800 Urinary Control System" -- that is, an artificial sphincter. What are your thoughts on this device or other similar artificial devices?
Andrea Richtel Branas MSE, MPT, Pelvic Floor Rehabilitation Team Leader, Penn Therapy & Fitness and Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
The internal sphincter to the urethra is often compromised during a prostatectomy. When this happens, the external sphincter is the only active mechanism to stop the flow of urine. The way to increase the pressure from the external sphincter is to strengthen the pelvic floor muscles. You can get assistance with strengthening these muscles by either seeing a urologic nurse or physical therapist who specializes in treating the pelvic floor region.
Using biofeedback and one-on-one teaching, the practitioner can teach you to use the pelvic floor muscles appropriately. This is a non-invasive approach to the problem and usually the first step to controlling incontinence after cancer surgery.
If this does not work, you may want to consider the AMS 800 device. The device is composed of a pressure-balloon reservoir, an inflate/deflate cuff, and a miniature control pump, which are implanted in the pelvic region. When the patient wants to void, he releases the control pump, emptying the fluid in the cuff into the reservoir. The fluid slowly returns to the cuff to close off the sphincter again. The device also has a locking mechanism and can be locked in the open position. The first version of the device was developed in 1972 and it has gone through many modifications and improvements over the years.
The device reportedly achieves "social continence", which is defined as 1 pad or less a day, in 75-95% of patients at the 3-year follow-up point. The largest study found that 90% of patients had a functioning device 5 years after placement. The device has an expected life of 10 years, so you would likely need to have it replaced over your lifetime. Between 25-35% of patients have some type of complication and require a second surgery to correct the problem. This can be related to mechanical problems with the device or patient related problems such as infection, tissue atrophy, or erosion of the cuff.
The most common use for the device is in post- prostatectomy patients. Most surgeons will wait 6 months to a year after surgery to implant the AMS 800, since many patients will regain continence on their own. The device is not used in women as often, but studies have found that success rates are about the same. Patients must be able to manually operate the pump and meet a few criteria for patient selection. The success is best when the device is inserted by an experienced urologist. Most importantly, patients must have realistic expectations, as the device is not likely to completely reverse incontinence.