What systems are available for the surgical treatment of urinary incontinence?
At the USZ, we offer three proven surgical procedures that all have the same goal: To significantly improve your urinary incontinence – but they work differently and are suitable for different degrees of severity.
Sphincter prosthesis – artificial sphincter (AMS 800)
A sphincter prosthesis is a medical implant that is used to treat severe urinary incontinence. The artificial sphincter imitates the natural sphincter by gently squeezing the urethra with a cuff. To urinate, briefly press a small pump in the scrotum to open the cuff. The system is considered the gold standard for men with moderate to severe incontinence, especially after prostate surgery, and can often help when other methods are no longer sufficient.
Explanatory video
AdVance XP sling
The AdVance XP sling is a fine, durable plastic band that lies under the urethra and lifts it slightly. This allows the rest of your own sphincter muscle to seal better again – you don’t notice the sling in everyday life and don’t have to operate anything. It is particularly suitable for men with mild to moderate stress incontinence (e.g. dribbling when coughing or exercising) and their own sphincter muscle is still relatively intact.
ATOMS sling system
With the ATOMS system, a small, fluid-filled cushion is placed under the urethra and anchored in the pelvis with thin straps. The pressure on the urethra can later be gradually adjusted via a chamber located under the skin. You do not have to actively operate the system in everyday life, and your doctor can increase or decrease the pressure if necessary in a short, usually only locally anesthetized session. ATOMS is suitable for mild to severe incontinence – even after radiotherapy for prostate cancer.
Explanatory video
Who are sphincter prostheses and sling systems suitable for?
Surgical procedures are only used if non-invasive measures (e.g. physiotherapy) and medication (antimuscarinics, sympathomimetics, Botox®) have not been successful. Before the operation, your doctor will carry out a thorough examination, including a cystoscopy and possibly a bladder pressure measurement, to ensure that the treatment is suitable for you.
Treatment
How successful is the treatment?
The treatment of male stress incontinence with sphincter prostheses and sling systems shows good to very good success rates and can improve quality of life. Most patients achieve what is known as social continence. This means that they need at most one “safety” insert per day in everyday life or can do without them altogether. However, occasional dribbling of urine may still occur after the operation.
How does the operation work?
The operation is performed under general anesthesia and usually takes half an hour to a maximum of two hours. The implants (sling, ATOMS cushion or artificial sphincter) are placed on the urethra via a small incision in the perineal area and the sling systems are anchored to the pelvis. With an artificial sphincter, the reservoir is usually inserted next to the bladder via a second incision in the lower abdomen. All parts are then closed under the skin.
After the operation, you will remain in hospital for a few days for monitoring. A bladder catheter will be in place until the first postoperative day and you will be given painkillers and instructions on which movements and strains you should avoid in the first few weeks.
Is surgical treatment of your incontinence the right choice for you?
The decision to use a sphincter prosthesis or a sling system should be made together with your urologist. Important considerations are:
- The severity of your incontinence
- Your general health and life expectancy
- Your ability to operate the pump
- Your expectations of the result
- Alternative treatment options
If you are interested in one of the surgical options for treating urinary incontinence, make an appointment at our urology clinic. Your quality of life is important to us. With the right treatment, most men with severe incontinence can lead an active and self-determined life again.
Frequently asked questions about sphincter prostheses and sling systems
All three systems – artificial sphincter, AdVance XP sling and ATOMS system – are designed for long-term use. In many cases, they function for many years, often ten years or more, before readjustment (especially with ATOMS) or replacement or corrective surgery may be necessary. Exact figures depend heavily on your individual situation, pre-existing conditions and stress levels and are therefore always explained in a personal consultation.
During sports or swimming, most patients hardly feel the implants, if at all. You usually get used to it quickly. Immediately after the operation, there may still be a feeling of tension or pressure when moving, but this usually subsides considerably as healing progresses, so that normal everyday and sports activities are possible again later.
Light activities are often possible again after 2-3 weeks, physically heavy work and sport should be avoided for approx. 6 weeks. Heavy lifting and contact sports in particular should only be resumed after consulting a doctor.
Yes, sexuality is still possible in principle. However, you should refrain from sexual intercourse for the first few weeks after the procedure until everything has healed well and your doctor has given the go-ahead.
Prosthesis material, surgery and the hospital stay of several days are mandatory benefits of the health insurance companies and are reimbursed. We recommend that you apply to your health insurance company for a cost approval before the procedure.
Yes. With the ATOMS system, the pressure can be adjusted several times via the filling chamber. This is done on an outpatient basis via the doctor. The artificial sphincter can be replaced or corrective surgery can be performed if problems occur. If the result after a sling operation is not sufficient, an artificial sphincter can be inserted later without any problems.
If a technical defect occurs, the artificial sphincter can be replaced in a second operation. In the meantime, you can use templates or templates plus condom urinal until the system is working again.
These systems are not usually visible from the outside. They lie completely in the body under the skin. Usually only the small pump of the artificial sphincter or the filling port (titanium port) of the ATOMS system in the scrotum area can be felt. Visually, nothing is normally noticeable in everyday life.
All three systems – artificial sphincter (sphincter prosthesis), AdVance XP sling and ATOMS system – are unproblematic for air travel. They are not affected by metal detectors or body scanners; it only makes sense to carry an implant ID card with you and show it at the security checkpoint if you are questioned.
In everyday life, the implants require practically no special care or maintenance on your part. You can shower, bathe and swim as usual. It is only important to attend check-ups with your urologist so that the function and position of the systems are checked regularly.
