Urology

Urinary incontinence in men is a serious problem that impacts the quality of life of millions of men around the world. The causes can be varied and, although many people believe that it is a "normal" condition of aging and that there is no cure, more and better methods are emerging to treat urinary incontinence, but one of the best without a doubt is the mesh bladder.

urology TREATMENTS

Mesh for urinary incontience

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  • VIDEO:   Male incontinence (in Spanish)
MESH FOR URINARY INCONTINENCE

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  • VIDEO:   Male incontinence (in Spanish)
Definition

What is the mesh for male urinary incontinence?

This treatment can significantly help men with urinary incontinence problems, especially when other procedures were insufficient and ineffective. Bladder mesh placement is a definitive treatment that brings improvement to almost everyone who undergoes it.

During this surgical-type procedure, a high-tech medical device similar to a tape or mesh is placed around the urethra, near the base of the penis, squeezing that duct and preventing urine from leaking when the patient is not urinating. voluntary way.

This treatment has helped thousands of men find a solution to a problem they had given up on for years: urinary incontinence.

This treatment has shown excellent results in cases of mild to moderate urinary incontinence, usually after prostate surgeries in which the entire gland is removed for cancer (radical prostatectomy).

But what is the problem with urinary incontinence?

Urinary incontinence is more of a problem than just annoying. Thousands of patients develop embarrassment and even fear of leaving home. This promotes isolation and depression.

The causes of urinary incontinence can be varied and each case is different from the others. However, if almost all patients have something in common, it is that, apart from perceiving difficulty in deciding to visit the urologist, urinary incontinence becomes increasingly severe over the years.

Doctor americano hablado con señor

Many might think “adult diapers are effective” and to some extent, this is true. Diapers can collect spilled urine and prevent it from wetting underwear or pants, but they are not a definitive solution to the problem.

Adult diapers are expensive and require changing several times a day (depending on the severity of urinary incontinence), but they are also uncomfortable and there is not always a bathroom nearby to change them.

Not only can urine spilled on underwear give off an unpleasant odor after a few minutes, but it can also irritate and inflame the skin of the crotch.

The bladder mesh solves the problem of urinary incontinence in a complete and definitive way. The patient may forget that he suffers from the problem and returns to enjoy a full life without fear or shame.

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Evaluación médica

How does this mesh or bladder band for urinary incontinence work?

During this procedure, the patient is taken to an operating room and an expert surgeon in this type of treatment inserts a band (or mesh) made of synthetic material inside the man’s pelvis, around the urethra, slightly compressing it and “pulling” it to that it takes on a different shape and the urine flow is occluded.

The urinary incontinence mesh supports the neck of the bladder which, in most cases, is hypotonic and without resistance to urine. For this reason the patient loses urine even when he does not want to.

The urethra is a single tube that carries urine stored in the bladder to the penis and the urethral opening at the tip of the limb during the voluntary action of urination.

If urine drips or comes out through the penis while the patient is not urinating, this is known as urinary incontinence and constitutes a pathology that should be evaluated by a urologist (that is, a specialist of the urinary tract in the men and women, and the pathologies that could appear in this region).

cirugia malla suburetral masculina

Cirugía malla suburetral masculina

When is bladder mesh indicated?

Bladder mesh is indicated as a definitive and radical surgical option in cases of male urinary incontinence in which conservative treatments such as medication and pelvic floor exercises were not effective and, therefore, the patient continues to present the problem.

In fact, and contrary to what you might think, involuntary urine leakage does not remain stable over time but tends to get worse.

Some patients begin by experiencing a discreet leakage of urine while walking, sleeping or working, but after a few months, years and even decades, the loss of urine and lack of control over urinary function becomes greater until the patient can discharge everything. the contents of the bladder in pants or bed.

This treatment is special in those patients s who developed urinary incontinence after prostate surgery because, while the gland or part of it (affected with cancer) is removed, the nerves to the penis and the bladder muscles are very often injured. In this case, urinary incontinence appears suddenly and is irreversible, but bladder mesh can be helpful.

What does the vesical mesh do?

Treatment Summary

The bladder mesh is placed, as the name implies, under the bladder to prevent unwanted loss of urine. It is a very novel type of treatment and it is safe to e is indicated to treat this condition. You can receive treatment at any of our centres in Madrid, Seville or Tenerife.

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What does the vesical mesh do?

The bladder mesh consists of a support element, made of high-tech synthetic materials, which supports the urethra close to the urethral bulb. This increases resistance to the flow of urine and therefore, to the involuntary loss of this fluid

What does the vesical mesh consist of?

The bladder mesh consists of a support element, made of high-tech synthetic materials, which supports the urethra close to the urethral bulb. This increases resistance to the flow of urine and therefore, to the involuntary loss of this fluid.

What kind of anesthesia is used?

The anesthesia used in this surgery is of a general type. The patient is previously subjected to sensitivity tests and this ensures the safety of this important element of the surgery. The average intervention time is less than one hour.

When is treatment indicated?

This treatment is indicated in patients with a diagnosis of mild to moderate urinary incontinence, especially in those who developed this condition after prostate surgeries (radical prostatectomies for cancer).

What are the results?

More than 70% of the patients who undergo this procedure achieve a remarkable improvement in terms of the non-voluntary loss of urine. Risks are rare and are associated with some pain in the area of the operation. This is a very safe and low-bleeding procedure.

THE PROCEDURE

Before the surgery

Before surgery, the patient must attend a couple of preoperative consultations at our Andromedi centres in Madrid, Seville or the Canary Islands (Tenerife) with the interventional urologist.

These consultations are completely essential for the performance of the surgery and their main objective is to assure the doctor that the patient’s health is in optimal conditions and in this way guarantee a good recovery and limit the possible complications that may occur during and after of the procedure.

The preoperative evaluation includes the following:

  • Complete medical history where, through an interview or medical anamnesis, the doctor questions the patient about her health, the habits she has and the illnesses she has suffered (including family illnesses).
  • Physical examination of the patient, especially urinary, renal and sexual function.
  • Blood tests, to check, among other things, the hemoglobin levels (if they are low, the patient has anemia), the hematocrit or percentage of red blood cells, the levels of white blood cells (which fight infections) and the prostate antigen specific, a substance that rises in cases of prostate enlargement in older men.
  • Urinalysis, to determine if there is a urinary tract infection (UTI) that could complicate recovery from surgery.

Other complementary tests to examine the bladder and urinary tract before surgery include:

  • A urodynamic (or urodynamic) study that helps to assess urinary function very precisely by inserting small sensors into the urinary tract up to the bladder.
  • A cystoscopy, which involves inserting a special, thin device through the urethra of the penis and into the bladder. This bladder catheter-like device has a tiny video camera at its end to view the urinary tract and determine the sites of compression or dilation

It is important to determine exactly where the incontinence problem originates so that the surgeon knows where to place the mesh that will prevent inadvertent loss of urine.

In addition to the consultation with the urologist in charge of the surgery, it is necessary to meet with the anesthesiologist to perform pre-anesthetic tests and in this way check that the patient does not have hypersensitivity to these drugs, which is rare but can occur.

What are the indications for the patient before surgery?

  • Avoid consuming anticoagulants during the two weeks prior to the operation to prevent bleeding. These types of drugs are indicated to reduce the risk of thrombi and heart attacks but can promote bleeding in recently operated patients and delay recovery. The main blood thinners are aspirin® (or acetylsalicylic acid), warfarin (Coumadin®), and clopidogrel (Plavix®).
  • Avoid the consumption of hard or difficult to digest food in the 24 hours prior to surgery. It is only possible to take fruit juices, soups or gelatin the night before the intervention to ensure that the intestines are clear and that the patient avoids pushing when evacuating them.
  • After 12am on the same day of surgery, the patient should avoid eating or drinking any food or drink and, if it is necessary to take any medication, it should be with a single sip of water.
  • Proper hygiene of the genital area is recommended before surgery. The patient should wash the entire crotch area with plenty of water and soap and, if possible, shave the pubic hair and the hair that grows on the perineum.

During surgery

Although it may seem like a complex procedure, the reality is that urethral mesh placement to treat urinary incontinence is an outpatient surgical treatment.

1 The patient is taken to an operating room and special devices will be placed to measure vital signs during the intervention. Then anesthesia is administered and the patient falls asleep.

2 The patient’s legs are raised on a special surgical bed in order to expose the site to be intervened.

3 The surgeon makes an incision in the perineum, the area between the scrotum and the anus, and exposes the urethra (the tube that carries urine from the bladder to the penis).

4. The surgeon takes a tape of synthetic material, identical to a “mesh” (hence the name of the procedure) and places it around the urethra near the urethral bulb, close to the urethral sphincter (the muscle responsible for holding urine to the be compressed gone almost all the time until the patient decides to urinate and relaxes).

5 5. When the urethral bulb is “wrapped” with the continence band or mesh, this “sling-like” mechanism slightly moves the urethra to a different position where there is greater resistance to the passage of urine.

6 The surgeon checks that the urethral mesh is positioned correctly and then closes the opening through which he was able to access the urethra with some stitches.

7 The surgeon inserts a urinary catheter into the urethra to drain urine from the bladder without great effort from the patient. 

When leaving the operating room, the patient must stay in the hospital for about 24 hours after surgery (sometimes this is less time). This is enough time for the effect of the anesthesia to pass and the patient to regain strength again.

The incision is usually sutured with absorbable thread (the body degrades it on its own and it is not necessary to remove the stitches). This suture can cause mild pain in the perineum but it is generally well tolerated and disappears on its own after a couple of days with some pain relievers, although sometimes they are not necessary.

Postoperative care

The patient remains in the hospital for a maximum of 24 hours after surgery. This is enough time for strength to regain after anesthesia and for doctors and nurses to assess the patient’s health status. When confirming that the patient is able to return home, he is discharged.

During the recovery period, the patient should consider the following helpful guidelines:

Keep physical rest

Not necessarily a complete rest, but avoiding making great efforts, running, riding a bicycle or practicing any sport.

Light walks are favorable

In the recovery process. Walking promotes blood supply to the lower areas of the body and stimulates healing.

Care of diet

During the recovery period it is important that the patient take care of his diet, ensuring that it is balanced and low in fat, processed products and sugars. Vegetables and fruit juices improve health and speed recovery.

Acetaminophen

If the patient is in pain, he can take over-the-counter pain relievers such as acetaminophen. Do not worry about pain unless it is very severe or disabling, where you need to see a doctor.

Caring for the operative wound is essential

The patient must wash daily with warm water and neutral soap. During the first days, the gauze compresses should be changed regularly, as indicated by the doctor, and avoid activities that promote the secretion of sweat in this area.

Symptomatology

Results

The vast majority of men who undergo this treatment overcome urinary incontinence almost completely within a few months. The recovery rate is well over 70% and those patients who continue to suffer from this medical condition may be candidates for an even more effective procedure: the artificial urinary sphincter.

Generally, patients who do not improve involuntary loss of urine after this treatment are those who previously had severe urinary incontinence from very aggressive prostate cancer surgeries.

Possible complications

All surgeries carry some degree of risk. Some involve more complications than others and, in the case of urethral mesh placement surgery, the complication rate is usually low.

However, complications can occur, especially in patients who neglected post-surgical recovery or who already had health conditions predisposing to infection or bleeding (the complications that often occur).

Other complications derived from this procedure can be:

Bleeding

Especially in patients with clotting problems or taking blood thinners. Also, in those patients who make great physical efforts during recovery.

Infections

Especially in patients with recurrent urinary tract infections or with immune problems (such as those taking steroids or are HIV positive).

Retention of urine

Because the urethra completely gave way to the tension of the mesh and was completely occluded. This is solved in a simple way with the placement of a urinary catheter for one or two more weeks. Eventually, the urethra recanalizes and the patient urinates normally again. In rarer cases, a second surgery is required but this is rare.

Urine leakage

In cases where the mesh was insufficient to generate urethral resistance to the passage of urine while the patient is not urinating. This leakage of urine can manifest as dripping into the underwear and should be reported to the doctor because it could indicate that the surgery was ineffective.

Irritation of the urethra and burning when urinating.

En los casos en que la malla fue insuficiente para generar resistencia uretral al paso de la orina mientras el paciente no esté orinando. Esta pérdida de orina puede manifestarse con goteo en la ropa interior y debe ser notificada al médico porque podría indicar que la cirugía fue inefectiva. 

When should I call the doctor?

The main reasons to call the doctor after surgery, or to see him immediately are:

  • Fever greater than 38 ° C (100.4 ° F).
  • Severe pain in the groin, in the pelvic area, in the genitals or when urinating.
  • Inability to urinate..
  • Bleeding in the urine.
  • Bleeding at the surgery site (perineum).
  • Heavy urine leakage or dribbling after a few months
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Advantages

Advantages of this treatment over others

Outpatient procedure

Although bladder mesh surgery to treat bladder incontinence may seem like a complex procedure, only one incision is made in the skin of the perineum and no more. The urethra is not cut or any other organ to insert the resistance mesh that prevents urine leakage, and for this reason, this surgery is considered outpatient (takes about an hour).

Short recovery time

When the word “surgery” or “surgical intervention” is heard, one usually thinks of long times of absolute rest, lying in bed and absenteeism from work and physical disability, but the recovery time after this treatment is only a couple of weeks ( rest at home) and then the patient can progressively return to their daily activities such as work and light exercise.

Low risks

The complication rate from this surgery is usually very low and the vast majority of patients successfully complete their recovery period. The risks tend to increase when the patient does not take into account the medical indications.

High effectiveness

Conventional treatments for urinary incontinence: drugs, Kegel exercises or adult diapers are NOT a definitive solution for this uncomfortable health condition for thousands of patients around the world.

The implantation of bladder mesh and artificial sphincter (another medical procedure) are the only two treatments capable of solving the root problem and, combined with conventional treatments, the prognosis of urinary incontinence is significantly improved

 

andromedi tratamiento titulares 02

"The recovery time after this treatment is only a couple of weeks (rest at home) and the complication rate for this surgery is usually very low".

Frequently asked questions at the Andromedi centres in Madrid, Seville and Tenerife

Except for blood thinners, what other medications should I avoid before surgery?

Pain relievers are the most widely used medications in the world and, unless disapproved of by your doctor, you can continue to use them to treat mild pain. However, some non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen should be avoided because they have some anticoagulant effect.

Antibiotics and drugs used to treat high blood pressure can continue to be taken without problem but they should ALWAYS be notified to the doctor, these and any other medicine.

How do I avoid dehydration if I cannot eat or drink before surgery?

As soon as the patient arrives at the hospital, the doctors and nurses will place IV solutions to keep him hydrated and stable, at least until after surgery when the patient can return to drinking water and eating soft, easy-to-digest foods.

Is it necessary to stay in the hospital long after surgery

No, generally the hospital stay after urethral mesh surgery is very short. The patient can return home 12 to 24 hours after the intervention. It is recommended to return home with a companion and in this way avoid driving a car or walking long distances. The anesthesia used can cause some drowsiness even a couple of days later.

How long is it necessary to have the bladder catheter inserted?

The bladder catheter or catheter is inserted into the urethra to drain urine after many interventions, especially those that are performed on the urinary tract, such as this surgery. In this case, the urinary catheter should remain in place for a couple of days after surgery or until the doctor deems it necessary.

However, the urination pattern does not normalize until a few weeks after surgery because the body needs to adapt to these new changes.

How long does the surgery take?

Generally speaking, this surgery usually lasts between 45 and 60 minutes.

Sometimes I feel like I'm the only one with urinary incontinence. How common is this problem?

This is a frequent urological problem, generally associated with age and that is very often not diagnosed correctly because many men hide it when they go for medical check-ups. The average prevalence in countries like Spain is around 29% of all men of advanced ages, this represents almost a third of the older male population.

MEDICAL REFERENCES AND BIBLIOGRAPHY
Este contenido médico ha sido actualizado y revisado por revisado por el comité científico de Andromedi en la siguiente fecha: 17 June 2022

Author

Dr. Natalio Cruz


Natalio Cruz MD, with 25 years of medical experience, has been until 2016 Head of the Andrology Unit in the Urology Service of the Virgen del Rocío Hospital in Seville, National Coordinator of Andrology in the Spanish Association of Urology (AEU) and General Secretary in the ESSM, positions that he has narrowed to focus squarely on this exciting project of offering a high-level private medical consultation in Marbella, Seville, Madrid and Tenerife.

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