by Richard Stephens, MD
Question: I had prostate cancer surgery 20 months ago, and have had continuing problems with incontinence. I turn 70 this June. My urologist says the best option for my individual situation (and I agree) is to have an artificial urinary sphincter implanted. He also said I will never be able to ride long distances again (I don’t want to agree). Rides as short as 25 miles are out. It seems to me that a noseless saddle or a totally split support (like one of the Dash versions) might allow me to continue my love of riding. I plan to take 4 months off the bike after the surgery. Any thoughts or information is appreciated. — Richard H
Dr. Richard Stephens Responds: I do not believe there would be a problem with riding long distances on a bike 4 months after the placement of the artificial urinary sphincter. I think Richard could ride as long as he wanted without causing any damage to the sphincter or the surgical area.
I believe the noseless saddle or a totally split support would offer greater comfort because the sphincter cuff is slightly bulky exactly where the nose of the seat would be touching. At the time of surgery, covering the cuff well with layers of adipose tissue might offer some cushion.
Some patients have problems with the artificial urinary sphincter in that they will have some leakage when sitting on a rounded surface in the perineal area. The coaptation of the urethra provided by the inflatable sphincter cuff could be briefly lost when a patient sits on a rounded surface in the perineal area, such as the rounded edge of the car seat as they slide out of the car. The bike seat could cause the same problem if were pressing on the perineum just right. A brief spurt of urine would occur at those times.
If he has minimal leakage, less than 2 – 3 pads per day, an Advance male urethral sling could be a better option because it would be less bulky than the minimally bulky artificial urinary sphincter. Richard would be a candidate for this only if he had less than 2-3 pads per day. He may be less likely to have the brief spurt of urine that could occur due to the perineal position of the nose of the saddle.
Richard Stephens, MD, is a board-certified specialist in Urology who practices in Alpharetta, Georgia.