July 31, 1997 By Melanie Fridl Ross
GAINESVILLE, Fla.---Using a technique akin to securing a hammock to a tree, UF surgeons have suspended the bladder within the abdomen to prevent urinary incontinence in men whose cancerous prostate glands have just been removed.
Removal of the prostate, known as radical prostatectomy, is the established treatment for managing prostate cancer that has not spread. More than 300,000 patients were diagnosed with prostate cancer in 1996, said Dr. Perinchery Narayan, chairman of urology at UF's College of Medicine. Nearly half will undergo surgery.
Incontinence plagues as many as 1 in 4 men after prostate surgery, in part because the bladder shifts to fill the 2- to 4-centimeter space left after the gland is extracted.
"Normally we all exert tremendous pressure on the bladder when we cough, sneeze or bend over and straighten out, but there is equal pressure on the bladder neck," Narayan said. "When the neck of the bladder shifts slightly below the abdomen, as often happens after prostate surgery, the pressure of those activities gets transferred out, and patients may leak urine."
Between 3 and 5 percent of patients will have incontinence so severe it requires them to wear pads.
"The numbers are variable," Narayan said. "If you consider any incontinence at all, even a drop or two when the patient coughs or sneezes, the incidence may be as high as 25 percent of patients."
Incontinence is more severe in patients older than 70 because their muscles are naturally weak.
To combat the problem, UF surgeons have begun taking fibrous connective tissue from elsewhere in the body, wrapping it around the bladder and tying it to muscles lining the abdomen.
The approach restores some of the normal anatomy and slightly compresses the neck of the bladder, said Narayan, who pioneered the 10-minute procedure a little more than a year ago.
"A combination of a little compression and the sling effect lifting up the bladder prevents many patients from leaking urine," he said. "This appears to reduce the incidence and degree of incontinence.
"Surgeons have tried a variety of techniques to prevent or correct incontinence," he added. "These include sparing some nerves that may be involved in maintaining continence and giving injections of collagen into the urethra. But still the problem continued.
It's unpredictable prior to surgery as to who will develop incontinence. While the percentage with more severe problems may be low, these patients are very devastated by this problem."
Furthermore, of the 30 men who have undergone the procedure, all were continent immediately after surgery, Narayan said. Normally, many patients experience temporary incontinence for up to three to six months after the operation.
"The patients we've operated on have been really happy, and we've not seen other problems," said Narayan, who presented his findings at this year's American Urological Association meeting and continues to study and modify the procedure. "Over a year's follow-up, they are voiding well and are continent."
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