Artificial Sphincter Restores Urinary Continence in Prostate Cancer Patients

Men who have undergone radical prostatectomy, prostate cancer radiation therapy, or other treatment resulting in significant urine leakage experience a high level of "social continence" with an artificial urinary sphincter.

The researchers, from University of California, San Francisco led by Dr. Jack W. McAninch, implanted the artificial urinary sphincter in 30 men with urinary incontinence, 26 of whom had been treated for prostate cancer. Of those 26 patients, 18 had the sphincter placed via a standard approach and 8 artificial sphincters were placed with a transcorporeal approach.

The investigators note that the devices have been in use since 1972; the newer transcorporeal approach was developed to allow placement in patients with urethral atrophy and previous urethral cuff erosion.

Two years of follow-up has shown that transcorporeal placement is an effective salvage or primary incontinence treatment for high-risk patients after prostate adenocarcinoma therapy".

"Patients operate the sphincter themselves," "There is a cuff that goes around the urethra and there is a pump placed in the patient's scrotum, which he can use to deflate the cuff, empty his bladder and then reinflate to close the urethra."

"From using 8 to 9 pads a day beforehand, patients were able to get down to only 1 or 2 pads a day. So, the patients were 'socially continent.'"

"The sphincter is far from perfect". "Only 69% of patients were socially continent" with standard placement of the sphincter, he said, while 81% of patients who had the sphincter placed transcorporeally achieved social continence.

"Infection is a risk, as it is a foreign body".  "If infection sets in, they have to remove the sphincter and start over...and erosion of the urethra can occur, but it is rare."

"Results are not perfect by any means at 69%, but prostate cancer patients are the largest population presenting with incontinence and the numbers are increasing," he said.

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