Male Incontinence Research Articles

Experiences and Outcomes of the Society of Genitourinary Reconstructive Surgeons Fellowship Training: Growth in Fellowships Mirrors the Evolution of the Discipline

ObjectiveTo describe experiences and outcomes of the Society of Genitourinary Reconstructive Surgeons (GURS) fellowship match. In 2012, GURS developed a centralized fellowship match which has grown from 13 to 30 programs. MethodsGURS match statistics and case logs were reviewed from 2013-2024. Additionally, a 37 question survey evaluating satisfaction, procedural competency, fellowship experience, and employment opportunities were sent to graduates. Linear regression was performed to examine trends over time. ResultsOver the study period, program match success remained stable (94.7%;p=0.50) while applicant success (63.3%) increased over time (p=0.04). North American and female applicants experienced higher match success (72.8% and 73.6%) compared to their international (35.5%;p<0.0001) and male counterparts (60.0%;p=0.02). On case log analysis, mean surgical volumes per year increased in urethral reconstruction (mean=88.1;p=0.02), male sexual health (n=32.7;p=0.03), genital reconstruction (mean=16.4;p<0.01) and abdominal reconstruction (mean=24.5;p=0.03). Male incontinence surgeries remained stable (mean=30.5;p=0.21) while female reconstruction declined (mean=23.2;p=0.01). With a survey response rate of 54.5% (97/178), training satisfaction was 95.9% which did not differ by gender (p=0.54) or year of training (p=0.22). 97.9% felt competent to enter unsupervised reconstructive practice, 94.8% reported an understanding of the relevant literature and 96.9% were satisfied with their job as a reconstructive urologist. 49.5% identified a different case mix in practice compared to fellowship, most commonly related to abdominal (44.9%) or genital reconstruction (16.3%). ConclusionGURS fellowships have grown organically over the last decade and mirror the growth and evolution of the discipline with sustained high-levels of graduate satisfaction, surgical experience, competence, scholarly inquiry and employment.

Lessons learned from the Sexual Medicine Society of North America fellowship bootcamp.

Sexual Medicine Society of North America (SMSNA) fellowships offer variable experience in sexual health domains: erectile dysfunction, Peyronie's disease, male infertility, male hypogonadism (low testosterone), reconstruction (including male incontinence), benign prostatic hyperplasia, gender affirmation surgery, sexual mental health, and female sexual dysfunction. To evaluate baseline and postbootcamp understanding and trust in these domains. In 2023, 28 of 31 urologists currently enrolled in SMSNA-endorsed fellowships participated in a 3.5-day training bootcamp in Minneapolis, Minnesota. Participants were asked to complete pre- and postbootcamp surveys. The bootcamp curriculum offered American Urological Association guidelines and case-based lectures, hands-on clinical training with cadavers (penile surgery) and models (collagenase training), and interaction with industry. Changes in knowledge, independence, and trust in performing the procedures, as well as billing issues and feedback for future bootcamps. Prebootcamp surveys revealed vastly varied residency experience. Reported time with an expert faculty member was greatest for benign prostatic hyperplasia and least for female sexual dysfunction, gender affirmation surgery, and low testosterone. The lowest prebootcamp confidence in performing surgery independently was for penile grafting procedures and elevating the neurovascular bundle. Postbootcamp results revealed several areas of significant improvement in confidence (P ≤ .03): intralesional injections for Peyronie's disease, manual modeling, penile plication, penile grafting procedures, and elevating the neurovascular bundle. There was a trend for improved confidence with the insertion of inflatable (P = .05) and semirigid (P = .08) penile prostheses. Nonsignificant improvement occurred in artificial urinary sphincter surgery (P = .12). Participants graded the bootcamp very highly and requested that next year's bootcamp have more content on female sexual dysfunction, male incontinence, and low testosterone, as well as more hands-on skills sessions and case-based lecture formats. Offering a bootcamp with hands-on instruction could significantly improve urologists' knowledge and confidence. As the main strength, this study was the first specialized bootcamp for urologists in the subject of men's health, taking into account hands-on and cadaver laboratories, as well as highlighting industrial and pharmaceutical products. The small sample size was the major limitation. Current SMSNA fellows present with varied levels of experience and confidence across sexual health domains. Notable confidence improvements were seen with topics that combined didactic lectures with hands-on trainings.

Outcomes of the Victo™ adjustable artificial urinary sphincter in the treatment of male incontinence.

To report the clinical outcomes of the Victo™ (Promedon, Cordoba, Argentina) adjustable artificial urinary sphincter (AUS) implantation in a cohort of patients with severe urinary incontinence (UI) after prostate surgery. This study enrolled patients with UI following prostate surgery who underwent a Victo implantation between May 2018 and December 2023. Patients were prospectively evaluated at baseline, and at 3 and 12 months after device activation, and thereafter annually. The 24-h pad-weight test (24hPWT) was used to assess severity of UI, while the Patient Global Impression of Improvement (PGI-I) and patient satisfaction according to a Likert scale were used to measure patient-reported outcomes. A total of 96 patients with a median (interquartile range [IQR]) age of 68 (65-72) years were included in the final analysis. The median (IQR) follow-up was 3 (1-4) years. In all, 10 patients completed the 5-year follow-up. After the treatment, we observed a significant reduction in 24hPWT by the median of 83% (P < 0.001) at 3 months and by a median of 79% (P < 0.001) at 3 years. According to the PGI-I, a total of 87%, 92%, 87%, 81%, 83%, and 50% (five of 10) of patients rated their condition/incontinence as 'very much improved', 'much improved' or 'little improved' at 3 months, 1-, 2-, 3-, 4-, and 5-year follow-up visits, respectively. The proportion of patients, who were 'very satisfied' or 'satisfied' with the treatment outcome was 79%, 80%, 75%, 69%, 80%, and 60% (six of 10) at 3 months, 1-, 2-, 3-, 4-, and 5-years, respectively. There were a total of 13 (14%) device failures during the follow-up period. In conclusion, our data suggest that Victo AUS significantly reduces the severity of UI after prostate surgery and provides a reasonably high patient-reported satisfaction with treatment outcomes at mid-term follow-up.

Structural health care reality in the surgical treatment of male stress incontinence in Germany

Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is adeficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschlüssel-German procedural classification) codes from hospital quality reports from 2011-2019. From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, ahigh number (≥ 50) of radical prostatectomies/year (RPE/year) is an independent predictor of ahigh-volume centre (≥ 10procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted ahigh number of slings (≥ 10slings/year; -69%; -62.4 ± 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34to 10; p < 0.001). This particularly affected departments that also had alow number of RPE/year (from 9to 0; -100%). The situation of surgical treatment of male stress urinary incontinence in Germany shows aclear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that agap in care has developed, as the decline was not compensated for by other surgical therapies.

A novel clinical classification for male urinary incontinence: MI-CRONS

Introduction:The aim of this study is to develop a new simple and practical classification of male urinary incontinence (UI) based on the clinical features and type of urinary incontinence. Materials & methods:MI-CRONS classification is a system based on severity of incontinence and patients’ characteristics. Clinical evaluation of incontinence severity is based on preservation of voiding, proportion of void/lost urine, absorbable device usage, level of physical efforts that causes urine loss and nocturnal incontinence. Following patients’ characteristics of patients were included in classification system: history of radical prostatectomy, history of pelvic radiation, surgery for prostatic obstruction, neurogenic or non-neurogenic bladder disorders, and urethral strictures and disorders. This MI-CRONS classification system uses five uppercase Latin letters as follows: Male Incontinence — Cancer, Radiation, Obstruction, Neurogenic, Stricture. The classification could be used for stress, urgency, and mixed UI forms. Results:The new MI-CRONS classification system was applied to 85 of 86 patients evaluated in this retrospective study. Patients were classified by MI-CRONS to estimate an inclusiveness and complicity of proposed classification only. One patient was not classified using the new MI-CRONS classification due to history of bladder exstrophy and augmentation cystoplasty. Most of the men studied had a stress form of urinary incontinence and the most common types were 2 (n = 18) and 3 (n = 17) after radical prostatectomy. Conclusion:The MI-CRONS has demonstrated prompt potential for classifying male incontinence of any type. The classification is a simple tool to describe these patients and could be useful for daily practice and clinical trials. Although further multicenter studies are needed to evaluate the predictive value of this tool. A Delphi consensus would be proposed with international experts for the further development of MI-CRONS.

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)

Comparative analysis of conventional penile clamps and Uriclak device in managing male incontinence following radical, turp, or laser prostate surgery.

This article examines the impact of various prostate surgery techniques on male urinary incontinence, evaluating the feasibility, efficacy, and safety of penile clamps as a post-prostate surgery treatment. The study compares the characteristics and applications of conventional penile clamps and the Uriclak urethral compression device, highlighting their differences and potential for managing male incontinence.

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction.

Between 8 and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals (NNUH) NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads. This audit aimed to assess patient satisfaction with this pathway and TENA Men pads. Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey. Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most liked, included 'easy', 'discreet', 'comfortable' and 'unobtrusive'. The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

Sleep-related disorders and lower urinary tract symptoms in middle-aged and elderly males: a cross-sectional study based on NHANES 2005-2008.

Lower urinary tract symptoms (LUTS) and sleep disorders both commonly affect people's quality of life. This study aimed to explore the associations between sleep-related disorders and LUTS through epidemiological investigations. Data were generated from the cross-sectional study called theNational Health and Nutrition Examination Survey (NHANES) 2005-2008. Multivariable logistic regression models were conducted to investigate the relationships between sleep-related disorders and LUTS. A total of 2516 men were included in the study.Participants sleeping ≤ 6h/night had higher odds ratios of LUTS (OR: 1.38; 95% CI 1.08, 1.77), daytime LUTS (OR: 1.26; 95% CI 1.03, 1.54), and nocturia (OR: 1.23; 95% CI 1.02, 1.49) than those sleeping 7-8h/night. Participants who required > 30 min to fall asleep had an approximately 39% higher odds ratios of nocturia than those who fell asleep within6to30min (OR: 1.39; 95% CI 1.12, 1.73). Sleep problems were positively related to LUTS (OR: 1.42; 95% CI 1.11, 1.82), daytime LUTS (OR: 1.32; 95% CI 1.08, 1.61), urinary hesitancy (OR: 1.75; 95% CI 1.31, 2.34), and nocturia (OR: 1.52; 95% CI 1.26, 1.84). Obstructive sleep apnea (OSA) symptoms were positively associated with urinary incontinence (OR: 1.52; 95% CI 1.12, 2.08). In addition, participants with daytime sleepiness were at higher prevalence of LUTS (OR: 1.66; 95% CI 1.29, 2.15), daytime LUTS (OR: 1.44; 95% CI 1.16, 1.78), urinary hesitancy (OR: 1.95; 95% CI 1.45, 2.63), and nocturia (OR: 1.66; 95% CI 1.35, 2.05). The findings suggested that sleep-related disorders were associated with LUTS, daytime LUTS, urinary hesitancy, incomplete emptying, urinary incontinence, and nocturia in middle-aged and elderly males.

Association of serum 25-hydroxyvitamin D with urinary incontinence in elderly men: evidence based on NHANES 2007-2014.

The correlation between serum 25-hydroxyvitamin D (25(OH)D) and different sub-types of urinary incontinence in elderly men continues to be uncertain. Hence, we performed this research to evaluate whether serum 25(OH)D levels are correlated with urinary incontinence among elderly men. The present study incorporated the male population aged 50 years and above from four cycles of the NHANES database spanning from 2007 to 2014, for the purpose of analysis. The assessment of urinary incontinence was carried out through a correlation questionnaire, while standardized liquid chromatography-tandem mass spectrometry (LC-MS/MS) was adopted to quantify serum 25(OH)D. A weighted multi-factorial logistic regression analysis was carried out to ascertain and investigate any potential correlation that may exist between serum 25(OH)D and urinary incontinence in senior males. Ultimately, a sum of 4663 elderly men were involved in our analysis. The outcomes of the univariable analysis illustrated that the group with vitamin D deficiency exhibited augmented odds of all three urinary incontinence types in comparison to the vitamin D-sufficient group. After accounting for age, race, and BMI, no appreciable variations in the outcomes were noticed. However, after accounting for all covariates, only SUI (OR = 1.677; 95% confidence interval (CI) = 1.074-2.618) and MUI (OR = 1.815; 95% confidence interval (CI) = 1.010-3.260) demonstrated statistical significance. Decreased serum 25(OH)D levels were connected with stress urinary incontinence and mixed urinary incontinence in elderly men.

Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study.

(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher's exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.

Insufficient utilization of care in male incontinence surgery: health care reality in Germany from 2006 to 2020 and a systematic review of the international literature

PurposeData suggest that the utilization of care in male incontinence surgery (MIS) is insufficient. The aim of this study was to analyse the utilization of care in MIS from 2006 to 2020 in Germany, relate this use to the number of radical prostatectomies (RP) and provide a systematic review of the international literature.MethodsWe analysed OPS codes using nationwide German billing data and hospitals’ quality reports from 2006 to 2020. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).ResultsMIS increased by + 68% from 2006 to 2011 (1843–3125; p = 0.009) but decreased by − 42% from 2011 to 2019 (3104–1799; p < 0.001). In 2020, only 1435 MISs were performed. In contrast, RP increased from 2014 to 2019 by 33% (20,760–27,509; p < 0.001). From 2012 to 2019, the number of artificial urinary sphincters (AUSs) changed minimally (− 12%; 1291–1136; p = 0.02). Sling/sling systems showed a decrease from 2011 to 2019 (− 68% 1632–523; p < 0.001). In 2019, 63% of patients received an AUS, 29% sling/sling systems, 6% paraurethral injections, and 2% other interventions. In 2019, few high-volume clinics [n = 27 (13%)] performed 55% of all AUS implantations, and few high-volume clinics [n = 10 (8%)] implanted 49% of retropubic slings.ConclusionMIS have exhibited a relevant decrease since 2011 despite the increase in RP numbers in Germany, indicating the insufficient utilization of care in MIS. The systematic review shows also an international deficit in the utilization of care in MIS.

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery.

(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.

MP60-04 CANNABIS USE IS A PREDICTOR OF HIGHER RATES OF URINARY INCONTINENCE IN BOTH MALES AND FEMALES; ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

You have accessJournal of UrologyCME1 Apr 2023MP60-04 CANNABIS USE IS A PREDICTOR OF HIGHER RATES OF URINARY INCONTINENCE IN BOTH MALES AND FEMALES; ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY Micah Levy, Christopher Connors, Chih Peng Chin, Krishna T. Ravivarapu, Olamide O. Omidele, and Michael A. Palese Micah LevyMicah Levy More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Krishna T. RavivarapuKrishna T. Ravivarapu More articles by this author , Olamide O. OmideleOlamide O. Omidele More articles by this author , and Michael A. PaleseMichael A. Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is little research exploring the possible association between cannabis use and urinary incontinence (UI). With cannabis legalization on the rise in the United States, it is important to understand how it may impact patients. We identified the impact of cannabis use on the rate and severity of urinary incontinence in male and female populations. METHODS: The National Health and Nutrition Examination Survey (NHANES) was queried from 2013-2018. Respondents were grouped as either using or never using cannabis. The rate of UI and UI subtypes (stress, urge, and overflow) were analyzed based on cannabis use. Symptom frequency was analyzed, with moderate symptoms defined as UI occurring less than once a week, and severe symptoms defined as UI occurring at least once a week. Multivariate analysis including age, race, education, income to poverty ratio, BMI, cigarette use, and parity was used to determine whether cannabis use is an independent predictor of UI. RESULTS: 3,391 males (1,506 [44.4%] used cannabis) and 3,570 females (987 [27.6%] used cannabis) were included in analysis. Cannabis use was associated with a greater rate of urinary incontinence in both males (13% vs. 7%, p<0.001) and females (42% vs. 34%, p<0.001). It was associated with greater rates of all three types of UI; stress UI in males (4% vs. 2%, p<0.001) and females (42% vs. 36%, p=0.008), urge UI in males (12% vs. 7%, p<0.001) and females (28% vs. 19%, p<0.001), and overflow UI in males (3% vs. 2%, p=0.017) and females (11% vs. 6%, p<0.001). Cannabis use was also associated with more severe symptom frequency in females (37% vs. 29%, p=0.009), but there was no difference in symptom frequency in males. Multivariate analysis showed cannabis to be a significant predictor of UI in both males (OR: 2.04, p<0.001) and in females (OR: 1.65, p=0.003) when controlling for other demographic variables. CONCLUSIONS: Cannabis use is an independent predictor of higher rates of urinary incontinence in both males and females and is associated with higher rates of all forms of urinary incontinence in males and females and with more frequent symptoms in females. With legal cannabis use on the rise, it is important to understand how it may affect the rate and severity of urinary incontinence in patients. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e843 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Levy More articles by this author Christopher Connors More articles by this author Chih Peng Chin More articles by this author Krishna T. Ravivarapu More articles by this author Olamide O. Omidele More articles by this author Michael A. Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Male Incontinence - An Overview and its Relationship to Benign Prostatic Enlargement

Male Incontinence - An Overview and its Relationship to Benign Prostatic Enlargement Abstract: Male urinary incontinence is a common disease in elderly men and can lead to a significantly reduced quality of life. Reported prevalence of urinary incontinence increases up to 32% in men over 85 years. Risk factors for urinary incontinence are prostate surgery, advanced age, immobility, urinary tract infections, diabetes mellitus, cognitive disorders, and neurological disease. Urinary incontinence is divided into three subtypes: stress urinary incontinence, urge urinary incontinence, and mixed urinary incontinence. Benign prostatic obstruction can lead to a detrusor overactivity and a further urge incontinence. However, iatrogenic injury or a preexisting weakness of the external urinary sphincter are more common and can lead to stress urinary incontinence in men following prostate surgery. A correct treatment can significantly improve symptoms in men suffering from urinary incontinence. Though, every treatment plan must be tailored to the individual patient.

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy (MP71)

You have accessJournal of UrologyCME1 Apr 2023Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy (MP71) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

MP25-19 TIME TREND ANALYSIS OF THE SOCIETY OF GENITOURINARY RECONSTRUCTIVE SURGEONS (GURS) FELLOWSHIP CASE LOGS: GROWTH IN TRAINING MAY REFLECT EVOLUTION OF THE DISCIPLINE

You have accessJournal of UrologyCME1 Apr 2023MP25-19 TIME TREND ANALYSIS OF THE SOCIETY OF GENITOURINARY RECONSTRUCTIVE SURGEONS (GURS) FELLOWSHIP CASE LOGS: GROWTH IN TRAINING MAY REFLECT EVOLUTION OF THE DISCIPLINE Ignacio Calvo, Jill C. Buckley, Pankaj Joshi, Drew Peterson, Hadley Wood, and Keith Rourke Ignacio CalvoIgnacio Calvo More articles by this author , Jill C. BuckleyJill C. Buckley More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Drew PetersonDrew Peterson More articles by this author , Hadley WoodHadley Wood More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Society of Genitourinary Reconstructive Surgeons (GURS) began a formal fellowship match over a decade ago, growing from 14 to 23 programs over this time period. With the growth in the number of fellowship programs, some have voiced concern about possible dilution of operative experiences for fellows. The objective of this study is to examine trends in GURS fellowship case logs over time to determine if fellowship operative experienced has changed. METHODS: Year-end surgical case logs submitted by GURS fellows from 2014-2022 were collated, analyzed and grouped into 6 categories:(1) Urethral reconstruction, (2) Male incontinence, (3) Male Sexual Health, (4) Genital reconstruction, (5) Abdominal reconstruction and (6) Female urology. Programs with more than 3 years of records were included and analyzed for time trends. Centers with more than one fellow per year were averaged. Lineal regression was used to evaluate for significant change over time. RESULTS: Overall, 152 case logs from 25 different programs were reviewed. On linear regression, urethral reconstruction volumes demonstrated significant increase over time (R2=0.036, B=3.2, p=0.02) with a mean volume per program of 88.1 cases/year. On individual center-based analysis, 89.9% of programs remained stable while 11.1% showed a significant increase in urethroplasty. Genital reconstruction also demonstrated a significant increase (R2=0.095, B=2.3, p<0.01) with a mean of 16.4 cases/year and 33.3% of the centers showing significant growth while the rest remained stable. Abdominal reconstruction also showed an increase over time (R2=0.023, B=1.2, p=0.03) with a mean of 24.5 cases/year and 16.7% demonstrating a significant increase while the rest remained stable. Male incontinence cases remained stable (R2=0.01, B=1.02, p=0.21) at a mean number of 30.5 cases/year with 83.3% of centers remaining stable, 5.6% increasing and 11.1% decreasing. Male sexual health showed a significant increase (R2=0.03, B=2.4, p=0.03) at a mean of 32.7 cases/year with 66.7% of the centers showing no significant change, 5.6% a decline and 27.8% having growth. Female urologic reconstruction demonstrated a significant decline (R2=0.04, B=-3.08, p=0.01) with a mean of 23.2 cases/year. CONCLUSIONS: Despite an increase in the number of fellowship programs, the GURS fellow operative experience remains preserved with significant increases in urethral, genital and abdominal reconstruction over the match period. Possible explanations include: growth in reconstructive urology as a discipline, consolidation of cases to academic centers, and expansion of service lines offered by GURS surgeons (e.g., gender affirming surgery, adult congenital care). Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e350 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ignacio Calvo More articles by this author Jill C. Buckley More articles by this author Pankaj Joshi More articles by this author Drew Peterson More articles by this author Hadley Wood More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

Pelvic Floor Muscle Training for Urinary Incontinence After Radical Prostatectomy: A Narrative Review.

Rehabilitative treatment of urinary incontinence after prostatectomy has showed, on the basis of recent published evidence, encouraging results. At first, clinician applied evaluation and treatment approach suggested based on the studies and rationale of female stress urinary incontinence, but although long term literature suggested no evidence of benefits. Recent studies that have shown the real control mechanisms in male continence through the use of trans-perineal ultrasound, demonstrated that it is not appropriate to transfer the rehabilitation techniques applied in female stress incontinence to male incontinence after prostatectomy. Even that pathophysiology of urinary incontinence after prostatectomy is not fully understood, it's in part attributable to a urethral or bladder source. In particular, however, urethral sphincter dysfunction is predominant, secondary to surgical damage and to the partly organic and partly functional dysfunction of the external urethral sphincter; complementary action of all the muscles capable of contributing to the maintenance of urethral resistance is therefore important. As for rehabilitative approach to post-prostatectomy incontinence, the primary objective is to quantify the residual capacity of the muscular function that must replace the sphincter function, often compromised by surgery. Than a multimodal approach, comprising exercise and instrumental therapies, is needed. The present paper's aim was to overview current urinary dysfunction knowledge for male with radical prostatectomy, and to describe practical issue of evaluation and conservative treatment.