Urinary incontinence is the loss of bladder control. It is a common and often embarrassing problem affecting both women and men. The severity can range from occasionally leaking urine when you cough or sneeze to having an accident from not making it to the bathroom in time.
There are four types of urinary incontinence: Stress Urinary Incontinence (SUI), Overactive Bladder (OAB), Mixed Incontinence (SUI & OAB), and Overflow Incontinence. Causes may differ for women and men. SUI is most common in older women, OAB affects both women and men, and Overflow Incontinence is mostly seen in men with prostate problems.
Damage to the nerves from diabetes or neurological diseases can cause under-activity of the bladder. Stroke, Parkinson’s disease, and Multiple sclerosis affect the brain and nervous system which can lead to urinary incontinence.
Urinary incontinence can impact emotional well-being. Many people avoid normal activities such as shopping, social events, exercise, and sexual activity. It is not hereditary, and it is not a normal part of aging. We are here to help you get back to enjoying life. There are numerous treatments available, so call to schedule a private consultation today.
Stress Urinary Incontinence (SUI) is the most common type of urine leakage for women. About 1 in 3 women will experience SUI at some point in their lifetime. Leakage happens when you cough, sneeze, laugh, lift, exercise or even bend over. Weak pelvic muscles let urine escape during these types of activities. SUI symptoms can range from mild to severe. Conservative therapies such as Kegel exercises and lifestyle changes are recommended first.
Surgical therapies, most commonly the urethral sling, is usually recommended next. Slings are made of a synthetic or biologic material that is compatible with the body. A small incision is made in the vagina to place it under the urethra. The sling provides support to the urethra and bladder to aid in eliminating urine leakage. It is an effective and minimally invasive surgical option usually performed in an outpatient setting.
The Coloplast Altis® Single Incision Sling
Urethral bulking is a procedure which involves the injection of a synthetic material into the urethra to partially close it. It helps to build up the thickness of the urethral wall to prevent urine leakage. This procedure is also done in an outpatient setting, but may have to be repeated to maintain improvement.
Overactive Bladder (OAB) is characterized by urine leakage from a sudden, uncontrollable urge. It is not the same as SUI. Please visit our OAB page for more information.
Mixed Incontinence is when women experience both SUI and OAB. Over half of women with SUI also experience OAB.
Overflow Incontinence is caused by a blockage or nerve damage. Men with this type of urinary incontinence do not feel that their bladders are full thereby causing leakage when it reaches its max capacity. One of the most common symptoms is urinating a small amount frequently. Another frequent symptom is a constant drip, or “dribbling.”
An enlarged prostate, a condition known as benign prostatic hyperplasia (BPH), can interfere with the passage of urine through the urethra. Men with BPH are at the most risk for Overflow Incontinence. Common symptoms include weak urine stream, urinary urgency and leakage, and frequent urination. Learn more about BPH on our Men’s Health Georgia website.
Urethral Stricture can also cause Overflow Incontinence. A stricture is a dense scar that occurs somewhere along the urethra. A stricture restricts the flow of urine from the bladder and can cause slowing of your urine stream, urine leakage or dribbling after urination, and spraying of the urine stream. Learn more on our Urethral Stricture page.
Treatments for Overflow Incontinence include medications, self-catheterization, and surgery.
Medications such as alpha blockers help to relax the base of the urethra to allow urine to flow more easily from the bladder.
Self-catheterization involves inserting a small catheter into the urethra yourself to help empty the bladder.
Prostate surgery may be recommended if the incontinence is being caused by a blockage. Learn more about Prostate surgery at our Men’s Health Georgia website.
Surgery for urethral strictures, or Urethroplasty, is varied and involves many different techniques. If strictures are short and in certain portions of the urethra, the area of the urethra can be surgically removed and the healthy urethra can be reconnected. If the urethral stricture is lengthy, then other tissues need to be used to reconstruct the urethra. Learn more on our Urethroplasty page.
Stress Urinary Incontinence (SUI) is leakage associated with activities such as sneezing, coughing, laughing, bending over, and athletic activities. This type of incontinence is usually seen after prostate surgery or an injury to the urinary sphincter muscle. Slings and artificial urinary sphincters are both effective treatment options when lifestyle changes do not help.
Men who have had prostate surgery are at increased risk for SUI. Radical prostatectomy, the complete removal of the prostate gland, is an effective treatment option to treat prostate cancer. The cure rates are very high, however one of the possible side effects is urinary incontinence from nerve and/or muscle damage during the surgery.
Synthetic slings are available to men usually suffering from post-prostatectomy incontinence. A small incision is made in the groin and the sling is placed to compress the urethra. It is a safe and effective procedure usually performed in an outpatient setting.
The Coloplast Virtue® Male Sling
An artificial urinary sphincter is an implantable device with an inflatable cuff that goes around the urethra. The cuff inflates automatically to keep the urethra closed. When the patient needs to urinate, he activates the pump in the scrotum to deflate it so the urine can flow out.
The AMS 800® Urinary Control System
Overactive Bladder (OAB) or Urge Urinary Incontinence is characterized by urine leakage from a sudden, uncontrollable urge that causes you to not make it to the bathroom in time. Radiation therapy for Prostate Cancer may cause temporary frequency and urgency problems, and more persistent problems in a small percentage of men. Please visit our OAB page for treatment information.
Mixed incontinence is a combination of the above types of urinary incontinence.
Artificial Urinary Sphincter
The AMS 800® Urinary Control System
What is it?
The AMS 800 is a device known as an “artificial urinary sphincter,” which is placed completely inside your body to provide simple, discreet urinary control. You control urination by squeezing and releasing a pump located in the scrotum.
The AMS 800 has proven to be safe and effective in treating moderate to severe male stress incontinence following prostate surgery, and is considered the gold standard by many urologists. When using this device, most men are dry with only minor leaks or dribbles of urine, usually only during strenuous exercise or exertion. Most men use a pad or less per day to manage these minor leaks.
What are the benefits?
Time-Tested: For 40 years, the AMS 800 has been the gold standard for treating incontinence due to intrinsic sphincter deficiency (ISD) following prostate surgery.
Effective: It is capable of offering most men with ISD the opportunity to achieve continence over time.
Long-Lasting: Published clinical data shows long-term results.
How does it work?
The AMS 800 artificial urinary sphincter mimics a healthy sphincter in that it keeps the urethra closed until you want to urinate. It does this by automatically moving fluid through 3 main components: a cuff, a pump, and a balloon. These components are connected by flexible, kink-resistant tubing.
When you need to urinate, you release the pressure on the urethra so that urine can flow. You do this by simply squeezing and releasing the pump located in your scrotum. This action pulls the fluid out of the cuff (which is wrapped around your urethra) and sends it to the balloon. Because the empty cuff is no longer pressing the urethra closed, the urine can flow out of the bladder.
Minutes after the bladder is empty, the fluid automatically returns from the balloon to the cuff. Once the cuff is refilled, the urethra is squeezed closed again.
The AMS 800 is placed during a surgical procedure, usually lasting about an hour and done under general anesthetic. One or 2 small incisions are made near the scrotum and at the abdomen to implant the cuff, balloon, and control pump. Before your surgery, your doctor should give you a thorough explanation of what will happen during the procedure and how to prepare for it. Your doctor should go over the surgical procedure in more detail and will describe the associated risks. Be sure to discuss any concerns with your doctor right away.
In general, placing an AMS 800 involves the following steps (your doctor’s method may vary slightly from this one):
The doctor makes an incision near the scrotum, performs dissection to the urethra, measures the urethra to determine the right size cuff, and positions the cuff around the urethra.
The balloon is then placed in the abdomen, and the pump is placed in the scrotum.
The tubing is connected between the components, and they are filled with a sterile fluid.
The doctor closes the incision.
Depending on your level of incontinence, your doctor may decide to use 2 cuffs to achieve better success. A second cuff has proven to be successful in providing more control for men with persistent, severe incontinence. You will not notice any difference in device operation if you have 2 cuffs.
What to Expect
Once your AMS 800 is activated, you will be able to control your urination by squeezing the control pump whenever you wish to empty your bladder. It is a good idea to get into the habit of emptying your bladder on a regular basis, such as every 2 to 3 hours.
You may also want to have someone else, such as a spouse, know how to operate the AMS 800 so that they can assist you if it becomes necessary.
Clinical Study Results
Since 1972, more than 150,000 patients throughout the world have received an artificial urinary sphincter. Clinical studies show that the AMS 800 remains an effective treatment option for male urinary incontinence.
In one study of 50 patients, 90% reported satisfaction.3 92% would have the AMS 800™ Urinary Control System placed again.3 Published clinical studies show that 59%-90% used 0-1 pad per day after the procedure.4
3. Montague, DK. Artificial urinary sphincter: long-term results and patient satisfaction. Adv Urol. 2012:835290. doi:10.1155/2012/835290.
4. Kahlon B, Baverstock RJ, Carlson K. Quality of life and patient satisfaction after artificial urinary sphincter. Can Urol Assoc J. 2011;5(4):268-272.
Is It Right for You?
The AMS 800 is a treatment option for men with moderate to severe stress urinary incontinence due to intrinsic sphincter deficiency (ISD) following prostate surgery. Some manual dexterity and strength are required to operate the pump, which controls the device.
If you have any of the following, the AMS 800 may not be right for you:
Physical or mental conditions that cause poor candidacy for surgical procedures and/or anesthesia
An irreversibly blocked lower urinary tract
Irresolvable detrusor hyperreflexia or bladder instability
Poor manual dexterity
The best way to determine if the AMS 800 Urinary Control System is right for you is to talk with your doctor.
Is it covered?
Medicare and most insurance carriers cover the cost of the AMS 800 Urinary Control System.
Medicare has a National Coverage Determinations (NCD) statement for Incontinence Control Devices (230.10). This NCD states that “such a device is covered when its use is reasonable and necessary for the individual patient.” To be sure, verify coverage with your insurance carrier or talk with your doctor. Please click here to review Medicare patient copay estimates for procedures utilizing AMS products in the outpatient hospital or ambulatory surgical center settings.
If you have questions about your Medicare benefits, you can contact AMS Health Care Affairs toll free with questions at (888) 865-3373 regarding procedures that utilize AMS products. If you have other general questions or need help with your Medicare benefits there is FREE ASSISTANCE AVAILABLE. The State Health Insurance Assistance Program (SHIP) has counselors in every state and several territories who are available to provide FREE one-on-one help with your Medicare questions or problems. Click here to visit Medicare’s Web site to locate a SHIP counselor in your area. Select SHIP from the Search by Organization Name drop-down menu to get started.
For private insurance carriers, AMS recommends that your doctor’s office send a written letter of predetermination to your private insurance company. This letter should ask if you meet the medical necessity requirements for the procedure in addition to verifying your individual policy has coverage for this procedure. Insurance companies typically send back a written response informing you if you meet both requirements.
What are the risks?
The AMS Sphincter 800 Urinary Prosthesis device family is intended to treat urinary incontinence caused by reduced outlet resistance (Intrinsic Sphincter Deficiency) following prostate surgery. The device is contraindicated in patients who are determined to be poor surgical candidates, have an irreversibly blocked lower urinary tract, have irresolvable detrusor hyperreflexia or bladder instability, or (for the AMS 800 with InhibiZone™) have a known sensitivity or allergy to rifampin, minocycline, or other tetracyclines. Patients with urinary tract infections, diabetes, spinal cord injuries, open sores, or regional skin infections may have increased infection risk. Device-skin erosion may occur. Proper patient evaluation, selection, and counseling on realistic expectations should occur. Possible adverse events include, but are not limited to, compromised device function, pain/discomfort, delayed would healing, migration and recurrent incontinence. Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, and potential adverse events. Rx Only.
Dr. Bhalani demonstrates placement of an Artificial Urinary Sphincter on a patient with post-prostatectomy urinary incontinence.
Atlanta Center for Urinary Control: The State’s Premier Provider of Urinary Control Treatment