Throw us a bone

by Donna Canada, RN, CURN

Managing urinary incontinence following prostate cancer treatments can take some ingenuity. Fortunately, a wide variety of products is sold at pharmacies, internet sites and specialty stores to help men cope with their incontinence problem. Most products are comfortable, discreet and allow you to continue with normal daily activities. The market for incontinence products is large and there are many reputable online home delivery companies or online stores that will ship in discreet packaging for those who may be embarrassed about the problem.

Preferences for product types vary. Some may prefer re-usable washables (tend to be less expensive over time) versus disposables. Male guard-type pads are available to cup the male anatomy and fit well in briefs. The guards are available for light (4 oz or less) to heavy (8 -10 oz) absorbency. For additional security, absorbent, protective underwear can be worn with an extra pad inserted inside. The inner pad can be changed when wet to extend wear of the brief and prevent the fear of leaking onto your clothing. Some vendors will send sample products for patients. One mistake many men make early on is to use their wife's sanitary napkins or pads. Sanitary napkins are developed for blood rather than urine and their absorbency is not as effective as pads engineered specifically for urine.

A recent advance in disposable products has been the addition of a superabsorbent polymer (SAP) to the inside material that significantly increases the total amount of fluid absorbed. Once a liquid is introduced, the SAP changes into a gel particle that swells with fluid but retains its original shape. The gel improves the pad's absorption capacity, minimizes urine leakage, and is pH balanced to control odor. These products also keep urine away from the perineal skin. Currently, SAPs can absorb up to 70 times their original weight in urine and swell to an average particle size of 1-2 mm. This absorbent inner core allows the urine to spread throughout the entire pad, facilitating absorption capacity while preventing urine leakage. ⁷

External devices for male incontinence after prostate treatment

External condom catheters

• Liberty Bioderm is a small, soft, hydrocolloid adhesive wafer in the shape of a flower that gently seals to the tip of the penis. A "faceplate" is wrapped around the wafer to make a custom seal over the glans penis. The end of the wafer directs the flow of urine into a tube for collection in a drainage bag.¹²
  
  
• Coloplast and GeeWhiz are external catheters consiting of a non-adhesive condom with a foam and elastic reusable band fastened with Velcro.
  
  
• AlphaDry is a small discreet product that holds approximately 12 to 20 oz of urine leakage. It is a combination of a one-piece condom catheter, one-way valve and reservoir that tucks neatly into a pair of brief-type underwear.
  
  
• AFEX is a cost effective and "green" product that is an alternative to using disposable pads. The AFEX is an adhesive-free external collection system that was developed by a prostate cancer survivor. The starter kit comes with 1 brief with receptacle, collection bag, cleanser, and instructional video. ¹³
  
  
• Omni by URINcare is a urine collection system with liquid sensors located inside the EZ-LifeKup that detect moisture and start the transfer of urine to the EZ-LifeBag that is worn on the lower calf.¹⁴

Urethral Inserts and Clamps

Technological advances include the development of internal and external, urethral compression and/or occlusive (air-tight) devices for both men and women. The characteristics of an ideal occlusive device would include:

• Efficacy (effectiveness)
• Comfort
• Ease of application/insertion/removal
• Lack of interference with normal voiding
• Lack of tissue damage
• Lack of infection
• No compromise of subsequent therapy
• Cosmetic acceptance and unobtrusive
• Lack of interference with sexual activity ⁷

Many products, such as the male urethral insert, are not yet available in the United States or are still awaiting FDA approval. The cornerstone of successful use of these products is patient education with medical support as needed.

Several compression devices (penile clamps) are worn externally on the penis:

• Cunningham Clamp by Bard
• Dribblestop male urinary incontinence clamp, which is adjustable
• Ppstop clamp
• C-3 male continence device is a Velcro-attached urethral occlusion pad
• ActiCuf is an absorbant small pad connected to a clamp that gently compresses the penis to prevent leakage 

All of these devices should be used exactly according to directions to prevent any bruising or damage to the penile tissue. Also, you must release any penile clamp every 1 to 2 hours to urinate, whether you feel you have to or not, to make sure that circulation is not impeded. Any of these devices can be accessed by search engine for more information. 

References:

1. SUNA 2010 Clinical Practice Guideline Prevention and Control of Catheter Associated urinary Tract Infection. Available at: http://www.suna.org. Accessed Feb.2, 2010.
2. Eastham et.al. Risk Factors for urinary incontinence after radical prostatectomy. J urol 1996;156L1707.
3. U.S. Dept of Health and Human Services,1996, Clinical Practice Guideline number 2 (Update). Rockville, MD Agency for health Care Policy and Research.Publication No. 96-0682.
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13. SeekWellness. Afex for managing male incontinence. Available at: www.seekwellness.com/male_incontinence/afex.htm. Accessed June 9, 2011.
14. Omni. URINCare. Available at: www.urinCare.com. Accessed on June 9, 2011.
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27. Bostwicket al. Complete Guide to Prostate Cancer. Atlanta: American Cancer Society; 2005:306-308.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted June 2011