Inserting an artificial sphincter around the outlet of the bladder can improve the urine leakage that many elderly men experience following removal of the prostate gland for cancer and other diseases. Age in itself is not a barrier to this treatment. The factors that made one reluctant to offer an artificial urinary sphincter to an elderly man includes poor manual dexterity and/or poor overall functional status (physical or mental). But, just because a patient is elderly doesn't mean that he won't be able to benefit from an artificial urinary sphincter for treatment of incontinence. Researchers from the Medical College of Wisconsin, Milwaukee, USA, evaluated outcomes of sphincter placement in 29 men, 75 to 83 years of age, who had incontinence after prostate removal. The artificial sphincter used by the group was the AMS 800, developed by Minnesota-based American Medical Systems. The device requires surgical placement and features three main components: a cuff, a pump, and a balloon. The cuff encircles the urine tube, or urethra, and most of the time it is inflated with salt-water fluid so that it squeezes the urethra and prevents urine leakage. When the patient wants to urinate, he presses and releases the pump, located in the scrotum, which causes the salt water to shift from the cuff into the balloon, allowing urination to occur. A few minutes later, the cuff refills automatically. It was found that the device markedly reduced the number of pads needed to deal with urine leakage. In fact, seven of the men no longer required any pads. Most men reported no complications and needed no additional intervention. However, four men required a revision of the sphincter and four patients required removal of the device. The results of the study have shown that elderly men do well after sphincter insertion for urinary incontinence after prostate removal. The procedure should not be withheld solely on the basis of patient age.
Urology,
February 2007