Question

My father had prostate cancer and so his prostate was removed. He has had a problem with incontinence ever since. A collagen injection failed to work. How useful is a mechanical spincter and are there any other options?

Answer

Each case is different and only each patient's physician can adequately answer this question. For example, it would probably be out of the question to put a mechanical sphincter in someone in whom the cancer had spread from the prostate, but it might be very reasonable to do so in a relatively young person if his cancer had been completely removed. It also depends on how much of a problem the incontinence is and how much it affects your father's quality of life.

Non-bladder causes of incontinence need to be excluded. These might include excessive output due to drugs or systemic illnesses such as diabetes mellitus, incontinence secondary to confusion or depression and so on. Since there is a very close correlation with his operation and the start of his problem it is reasonable to suggest the two are connected in your father's case. But this is not always so, as symptoms may well have been present before an operation or a sudden medical illness, and become overt only as the result of a disability that has arisen at the time when the symptoms seemed to have started. An example might be if your father's mobility has been impaired in any way since the operation.

Once a urological cause for the incontinence has been ascertained, then full investigation of the bladder and the sphincter is important. If the tests show that there is damage to the sphincter, this is very difficult to fix in men in any other way than with an operation. However, mechanical sphincters do not last forever, nor are they problem free, and of course to have them implanted is quite a major operation. Different surgeons have different success and complication rates for operations.

Links

• Prostate problems