FR02-05 THE EVOLUTION OF MANAGEMENT OF MALE URINARY INCONTINENCE

Abstract

INTRODUCTION AND OBJECTIVE: The struggle to treat male urinary incontinence (UI) dates back centuries, with descriptions of UI in Egyptian manuscripts as early as 1500 BCE. In this review, we chronicle the history of UI interventions that have educated the modern options available to us today. METHODS: A comprehensive literature review was performed to elucidate relevant historical and clinical information. RESULTS: Various strategies have been employed for managing UI, including storage and barrier devices, urethral bulking agents, and surgical implants. While storage devices in some form have been used for centuries, French surgeon Ambrose Pare is credited with developing the first portable urinals in 1564. In the 1600s, Wilhelm Hildanus, ‘father of German surgery’, created the first documented condom catheter and the first penile clamp. A modern version of his invention, the Cunningham Clamp, was popularized in the 1980s. Urethral bulking agents for treating UI have been used since the late 19th century. Dr. Robert Gersuny, a surgeon famous for his discovery of paraffin and Vaseline as media for injection, attempted to cure UI by injecting paraffin into periurethral tissue with mixed outcomes. Since then, various bulking agents have been shown to improve coaptation of the sphincteric zone. Lorenz Heister invented the first recorded surgical device for compressing the bulbar urethra to treat UI in 1747. Two hundred years later, Frederic Foley created a urinary sphincter, which was worn around a surgically isolated segment of corpus spongiosum. In the 1960s, surgeons attempted to reduce UI by attaching the 7th rib to the pubic bone to reduce undesired voiding. In 1973, F. Brantley Scott created the first multi-component artificial urinary sphincter (AUS), which remains the benchmark therapy for UI today. In the 1960s, John Berry described an acrylic mesh urethral sling, which was implanted ventrally into the bulbar urethra and attached to the pubic ramus. Joseph Kaufman invented a similar silicone sling in the 1970s. Early on, these devices were fraught with complications, including urethral erosion, fistulas, and pain. More recently, the transobturator male sling, which came to market during the 2000s, has become an option for select men. CONCLUSIONS: The modern devices we use for the treatment of IU are evolutionary byproducts of centuries of experimental designs by pioneering surgeons from around the world. While the materials have improved, barriers, storage devices and bulking agents almost identical to the versions first invented remain in use today. The electronic AUS will usher in the next phase of advancement in this field. Source of Funding: None.