A Device to Restore Urinary Continence after Prostate Cancer Treatment
by Doug Scott, a founding member of CPCN

For some men, an unfortunate side-effect of prostate cancer treatment can be some degree of permanent urinary incontinence, ranging from mild to moderate to severe. Particularly for men with advanced-moderate to severe incontinence, this can cause discomfort, hygiene problems, and considerable inconvenience, and can interfere with regular activities and detract from quality of life. An option these men may wish to consider is the surgical insertion of an artificial urinary sphincter device which can effectively restore continence and greatly improve their quality of life.

I speak from personal experience. I am 73 years old and live in Toronto. In 1995, I had a radical prostatectomy for a quite aggressive (Gleason 7) late-diagnosed (PSA 25) prostate cancer. Within two years, I had recovered about 98% urinary continence. In 1999, I had a not surprising PSA rise, indicating residual disease. I had external beam radiation treatment on the probability of cancer still localized in the prostate bed. The good news is that the radiation treatment controlled (hopefully eradicated; time will tell) the residual disease. (PSA has been undetectable for 6 1/2 years.) The bad news is that the radiation, on top of the surgery, left me with extreme urinary incontinence. I knew about the artificial urinary sphincter, but did not like the idea of this foreign body, mechanical device - including the small activating pump in my scrotum - inside my body. So I lived with the condition.

After six years of living with the discomfort and inconvenience, I decided to explore more seriously the artificial sphincter device. I saw two leading urologic surgeons - 2-3 months wait for appointments - (at Toronto Western Hospital and Sunnybrook Health Sciences Centre) and had complete urodynamics tests to determine if I was a good candidate for this surgery and this device. Both advised me that I would probably experience a good outcome. I had the surgery six weeks later in early June at Toronto Western Hospital. The three-hour surgery was successful with no complications, and there was a two-day hospital stay for monitoring and antibiotics. I was pleasantly surprised that I had no post-surgery pain - only some soreness and tenderness at the sites of the two incisions. A small inflatable cuff was installed around the urethra, just below and behind the scrotum. A small reservoir was inserted in the lower abdomen through a 1 1/2 inch incision on the prostatectomy scar. The small activating pump was inserted through this same incision, moved down and positioned in the scrotum. Slim double-tubing connects the three parts of the device. When the pump is pressed, the cuff is deflated allowing urine to flow freely. In a few minutes, the cuff automatically re-inflates and the urethra is sealed off again. [Click here for more information and a picture from the Prostate Cancer Research Institute.]

After the surgery, there is a 6-8 week healing period (in my case, 8 weeks, since radiated tissue and circulatory systems can take longer to recover.) In early August, I saw my excellent surgeon who activated the device and instructed me in its operation, which is very simple. There is no leakage except for the few minutes required for re-inflation after urination. I am immeasurably pleased with the recovery of virtually complete urinary continence. It's terrific and has greatly improved my quality of life. For men who are experiencing a significantly bothersome level of permanent urinary incontinence after prostate cancer treatment, I recommend this device without reservation. If you are interested, consult your family physician for a referral to a specializing urologic surgeon. If you want more information about my own experience, you can contact me by email at douglasmscott@rogers.com or by telephone at (416) 486-4898. I welcome your inquiries.