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Major trial for male incontinence

JeremyOckrimConsultant Urologist Jeremy Ockrim is leading a major trial comparing, for the first time, the two surgical treatments for male stress incontinence.

For men with long term stress incontinence, the most established surgical option has been the Artificial Urinary Sphincter (AUS).

The device has high success rates, reported at around 90 per cent, but has significant implications for the patient.

“It involves inserting a mechanical device. In order to pass urine it is necessary to activate a pump located within the scrotum, ” explains Mr Ockrim.

“Some patients have lived with serious incontinence for a long time and are prepared to manage the device in order to address their symptoms.

“Others find the idea of the device more difficult to contemplate.”

While the AUS has been in use for over 30 years, in 2006 an alternative treatment was introduced. It is called the male sling because it is based on the same principles as the more established sling for women with incontinence.

“Implanting the male sling is less invasive than the AUS. However, there is huge variation in reported success rates for the male sling, from 12 per cent to 70 per cent.

“This study is really important because it is the first in the world to directly compare the effectiveness of these two treatments.”

Mr Ockrim is leading the study in his NHS role at the Institute of Urology, University College Hospital, where he receives referrals from throughout the UK for patients with complex incontinence. The unit has the huge experience dealing with men with post prostatectomy incontinence.

The trial will start in June 2012 and last for one year, with national and international recruitment.

Patients will be assessed and the trial will be open to patients with mild and moderate incontinence.

Their treatment will be randomised, although if patients strongly prefer one type of treatment over the other, their wishes will be respected.

“The results of this study will help us to improve the information we give to patients considering the AUS and male sling.

“At the moment, we can say that the male sling seems more effective if incontinence is at the milder end of the spectrum. However, we want to be able to give patients more detail in terms of how effective they can expect the treatments to be, so they can take this into consideration together with their thoughts about how they would cope with each approach.”