Patients experiencing urinary incontinence to the degree that it is altering their lifestyle should seek consultation with a skilled urologist—particularly if the patient has had surgical treatment for prostate disease. Patients are well advised to seek out a urologist who is experienced in dealing with urinary incontinence and with the surgical treatments that have proven so successful in treating this problem. The science of understanding bladder and sphincter function is known as urodynamics. This discipline allows researchers to measure pressure in the bladder when it’s low and when it’s high; quantify the resistance at the sphincter muscle; and gauge the flow rate of urine at the time of urination. If incontinence is present, measurements can be taken at the time of leakage.
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Male Urinary Incontinence: Coordination
Normal urination requires coordination between the urinary bladder and the sphincter, which is the urinary shut-off valve. The urinary bladder has only two functions: storage and elimination of urine. In the storage phase, the bladder muscle relaxes; it operates with a unique concept known as compliance. Compliance means that the muscle bundles within the bladder slide one over the other to allow the bladder to increase in volume without increasing pressure. The urinary sphincter is a muscle group that contracts at the time of storage and relaxes when bladder contraction occurs, increasing pressure. This relaxation of the urinary sphincter allows the urine to flow freely out. The coordination of these muscle groups allow humans to store and eliminate urine under conscious control. Urinary incontinence occurs when the function of the bladder and the sphincter become uncoordinated. There are two circumstances that lead to urinary incontinence: the first is physical stress, and the second is inappropriate reflex activity of the bladder. This second circumstance is known as urge or spastic bladder contraction. Using urodynamics, the urologist can determine if bladder function is normal, or can be converted to normal, by the use of medications. The urologist can also determine if the sphincter is working properly.
Urinary Incontinence in Men: An Age-old Problem
The problem of urinary incontinence due to sphincter malfunction related to prostate disease among men has been known for centuries. The history of this problem dates back to the work of Hippocrates in 460-377 B.C., credited with being the first physician to reject superstitions and beliefs that credited supernatural or divine forces with causing illness. Urinary incontinence remained a problem throughout the ages until the device known as the artificial sphincter was developed by Dr. Brantley Scott in 1972.
New Treatments for Urinary Incontinence in Men
The most common indication for placement of an artificial sphincter occurs in men who’ve had prior prostate surgery, most frequently after prostatectomy performed to treat prostate cancer. Dr. Riemenschneider had the privilege of working with Dr. Scott during the development years of this revolutionary device and has had long experience in implanting it. The artificial sphincter consists of a balloon reservoir that can have various pressures according to what is required; a cuff, which is placed around the urethra to produce resistance; and a control pump placed in the scrotum where it can easily be manipulated by the patient. The control pump contains a valve mechanism, a pump and a locking mechanism. When the device has been placed and the cuff pressurized, a resistance similar to that of a healthy sphincter allows the patient to recover and maintain urinary continence. The procedure of implanting the artificial sphincter is minimally invasive; however, successful implantation requires a clear and detailed understanding of the device and the methods of implantation so that the urinary tract is not damaged and the function of the sphincter is not compromised.
Dr. Riemenschneider has extensive experience in researching and treating urinary incontinence with the artificial sphincter—not only in men, but in women as well. In the past, successful completion of this procedure has required a highly sophisticated hospital environment. Today, the device has evolved and knowledge of incontinence has grown to the point where patient selection and appropriate implantation techniques can be provided as an outpatient procedure, frequently completed in an Ambulatory Surgery Center.At Riverside Urology, we often utilize The Knightsbridge Surgery Center for these procedures. Our patients come to the Knightsbridge Center and, after admission, are brought to our fully-equipped operating room for approximately one and a half hours. Usually, patients are sent home within three hours of the time of admission. Normally, the artificial sphincter is activated within four to six weeks, and incontinence becomes a non-issue.Our entire staff is very interested in serving you. If you have questions or would like to have a consultation, please contact us through this website. We will be in touch with you promptly.