Management Of Incontinence Research Articles

MRI-Based Radiomics Analysis of Levator Ani Muscle for Predicting Urine Incontinence after Robot-Assisted Radical Prostatectomy.

The exact role of the levator ani (LA) muscle in male continence remains unclear, and so this study aims to shed light on the topic by characterizing MRI-derived radiomic features of LA muscle and their association with postoperative incontinence in men undergoing prostatectomy. In this retrospective study, 140 patients who underwent robot-assisted radical prostatectomy (RARP) for prostate cancer using preoperative MRI were identified. A biomarker discovery approach based on the optimal biomarker (OBM) method was used to extract features from MRI images, including morphological, intensity-based, and texture-based features of the LA muscle, along with clinical variables. Mathematical models were created using subsets of features and were evaluated based on their ability to predict continence outcomes. Univariate analysis showed that the best discriminators between continent and incontinent patients were patients age and features related to LA muscle texture. The proposed feature selection approach found that the best classifier used six features: age, LA muscle texture properties, and the ratio between LA size descriptors. This configuration produced a classification accuracy of 0.84 with a sensitivity of 0.90, specificity of 0.75, and an area under the ROC curve of 0.89. This study found that certain patient factors, such as increased age and specific texture properties of the LA muscle, can increase the odds of incontinence after RARP. The results showed that the proposed approach was highly effective and could distinguish and predict continents from incontinent patients with high accuracy.

CLINICAL MANAGEMENT OF URINARY INCONTINENCE IN WOMEN BY FAMILY HEALTH STRATEGY NURSES

Objective: To analyze the performance of nurses from the Family Health Strategy (ESF) in the clinical management of urinary incontinence in women in a planning area in the city of Rio de Janeiro (RJ), Brazil. Method: Descriptive research, with a quantitative approach, was carried out in seven Basic Health Units, in the city of Rio de Janeiro. The sample consisted of 27 nurses who worked in the ESF. Data analysis was performed using simple descriptive statistics, with a description of relative and absolute frequency. Results: Weaknesses were shown in the identification of aspects involving an early approach, risk factors for its development, treatment, and educational activities. Conclusion: Despite recognizing that the ESF has the resources for the treatment of uncomplicated urinary incontinence, some actions are not carried out by the nurses, such as involving the team in the care of women with this condition, prescribing exercises to strengthen the pelvic floor and evaluating and carry out non-pharmacologicaltreatment, as well as the investigation of women without complaints of urinary loss. Therefore, the results indicate the urgent need for training of nurses who work in the ESF.

Physiotherapy Management of Urinary and Fecal Incontinence in a Nulliparous Young Athlete Treatment. A Case Report

Physiotherapy Management of Urinary and Fecal Incontinence in a Nulliparous Young Athlete Treatment. A Case Report

Current surgical management of postprostatectomy incontinence — Workup, options and decision making

This article gives a current overview of surgical options and limits of surgical post-prostatectomy incontinence (PPI) therapy and reflects the contents of workshop 6 at the ICS meeting in Vienna, Austria 2022.The decision-making process in PPI requires consideration of various dimensions from presentation to determination of treatment. Patient factors include the severity of symptoms, age and health condition, comorbidities, and patient’s expectations. Also important are the type of prior prostate surgery, radiation therapy, and status of cure.Only an accurate diagnosis will lead to the most effective management option being chosen. An accurate history, standardized questionnaires, physical examination, and 24-hour pad-weights are essential. Transperineal ultrasound, urethrocystoscopy with a urethral repositioning test, and multichannel urodynamics are useful in assessing sphincter and bladder function, as well as the anastomotic region after radical prostatectomy.The effect of various treatment options, such as slings, balloons, and artificial hydraulic sphincters can now be evaluated with long-term studies. The most widely used type of sling is the two-arm fixed sling with a dry rate of 58% and overall improvement rate of 83% at 5 years. Prior pelvic irradiation may reduce the long-term success rate. Adjustable devices offer the opportunity of adaptation to a potentially changing degree of incontinence to meet individual patients’ needs. Adjustable male slings support the bulbar urethra with a minimal increase of urethral resistanceThe artificial urinary sphincter (AUS) is the most predictably reliable treatment for men with moderate to severe stress incontinence with social continence rates of 79%. Device revision is required for recurrent incontinence with options including cuff repositioning, downsizing, or transcorporal cuff placement. Alternative hydraulic sphincter systems offer the possibility of postoperative adjustment by changing the intra-device pressure. Recent developments include electrical and remotely controlled devices not yet commercially available. Further factors of the decision-making process are the skills of the surgeon, individual preferences, and product availability.

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

Management of female stress urinary incontinence with single-incision mini-sling (Altis®): 36 month multicenter outcomes.

To assess noninferiority of the safety and effectiveness of the Altis® Single Incision Sling (SIS) with standard midurethral transobturator and/or retropubic slings through 36 months in a prospective, longitudinal, nonrandomized USFood and Drug Administration (FDA) 522 cohort study. Adult females with confirmed predominant stress urinary incontinence (UI) through cough stress test (CST) or urodynamics and failed two noninvasive incontinence therapies. Effectiveness endpoints included objective dryness, negative CST, adverse events, and revision/resurgery through 36 months. The primary effectiveness endpoint was reduction from baseline in 24-h pad weight of ≥50% at 6 months, as requested by the FDA, and is included as a study point in this paper. Primary safety endpoint was rate of related serious adverse events (SAE) through 36 months. Noninferiority margins of 15% and 10% were prespecified for the effectiveness and safety endpoints. Due to the observational nature of the cohort study, a propensity methodology was conducted to assess the effect of potential confounding variables on the primary endpoints between groups. Three hundred fifty-fivewomen underwent the sling procedure (n = 184 Altis; n = 171 Comparator). One hundred fourty(76%) Altis subjects and 101 (59%) Comparator subjects completed follow-up through 36 months. At 36 months, for the effectiveness endpoint, the difference in proportions of -0.005 for Altis versus Comparator (95% confidence interval [CI]: -0.102 to 0.092) was statistically significant (p = 0.002), supporting the hypothesis that Altis is noninferior to Comparator. Furthermore, both groups demonstrated high objective efficacy; in the Altis arm n = 99 (81.8%) subjects were a success, and in the Comparator arm, n = 79 (82.3%) subjects were a success. Additionally, regarding the CST, Altis was found to be noninferior to the Comparator at every study visit, and the rate of negative CST remained above 80% for both groups (p < 0.001). At 36 months, Altis (n = 2; 1.1%) and Comparator (n = 4; 2.3%) subjects experienced a device and/or procedure-related SAE. The difference in proportions of 0.013 for Altis versus Comparator (95%CI: -0.023 to 0.048) was statistically significant (p < 0.001), demonstrating that Altis is noninferior to Comparator with respect to the primary safety endpoint throughout the study. There were 62 (36.3%) retropubic midurethral slings (RMUS), 96 (56.1%) transobturator midurethral slings (TMUS), and 13 (7.6%) SIS slings in the Comparator group. For the 36 month effectiveness endpoint, assessing the noninferiority of Altis versus RMUS and Altis versus TMUS, 99 (81.8%) Altis and 37 (90.2%) RMUS were a success, trending toward statistical significance, however, it cannot be determined to be noninferior (p = 0.092). Ninty-nine(81.8%) Altis and 33 (71.7%) TMUS were a success; this was statistically significant (p < 0.001), demonstrating Altis was noninferior to TMUS. Rates of negative CST were 122 (87.1%) Altis, 40 (93.0%) RMUS (p < 0.001), and 44 (91.7%) TMUS (p < 0.001). CST demonstrated that Altis was noninferior to RMUS and Altis was noninferior to TMUS at 36 months. Altis single-incision sling was noninferior to standard midurethral sling for treatment of stress UI, throughout the study and at 36 months. Furthermore, adverse event rates were low.

Leveraging Radiopharmaceutical Programmatic Collaboration for Management of Pretherapy and On-treatment Urinary Incontinence.

Many parenteral radiopharmaceuticals available as anticancer therapy are filtered by the kidneys and excreted in the urine. Here, physician leaders of radiation medicine, nuclear medicine/molecular imaging, and the radiotheranostics programs as well as radiation safety officers, collaborated to develop a decision-making guideline for the administration of therapeutic radiopharmaceuticals in patients with pretherapy or day-of-treatment incontinence. We discussed challenges and opportunities in the screening of patients in urine collection strategies according to grade of urinary incontinence and in subsequent coordination of care. Lutetium-177 ( 177 Lu)-based radiopharmaceutical therapies provided clinical examples of how our procedures were operationalized. Our key management issues of urinary incontinence were cutaneous radiation injury and redness, infection, or pain. In response, we developed clinical practice guidelines for the recognition and management of incontinence-related adverse events. Common adverse events of urinary incontinence were noted in this study. Our how-to guideline for the safe administration of therapeutic radiopharmaceuticals for patients with urinary incontinence warrants further investigation and should continue to be evaluated across all radiopharmaceutical therapy agents.

The future of bladder and bowel care in Wales: translating policy into action

The formation of public policy relies on decisions made by the political leadership within a government. However, these decisions are usually shaped by a multitude of other factors and different stakeholders, including civil servants, professionals and citizens. Nonetheless, how is policy made and how is this translated into action? Sue Thomas highlights how a parliamentary debate in Wales is set to influence policy making in the Wales principality for the management of incontinence.

Patient preferences for stress urinary incontinence treatments: a discrete choice experiment

ObjectivesTo elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women.DesignA discrete choice experiment survey to elicit preferences for type of...

Retropubic tape surgery for stress urinary incontinence: can women be cured without voiding dysfunction?

Retropubic tension free vaginal tape (RP-TVT) has become the gold standard for surgical management of female stress urinary incontinence but is associated with voiding dysfunction (VD). We developed for more than 10years a reproductible and totally tension free tape procedure. Our goal is to determine efficiency of this technique compared to the incidence of VD. We retrospectively reviewed patients who underwent RP-TVT in our center between 2011 and 2019. Subjective cure, VD (determined as maximum urinary flow rate (Qmax) < 15mL/s or post void residual (PVR) volume > 150mL, or tape's section or resection requirement for underactive bladder (UB) with significant PVR) was assessed at 1year. The main objective was the evaluation of subjective cure and VD at 1year. On the 319 patients reviewed, 93% of the patients were dry and 10.9% presented VD at one year. UB (OR = 5.01 [1.55-16.44], p = 0.008), preoperative Qmax < 15mL/s (OR = 0.89 [0.84-0.95], p = 0.001) and previous incontinence surgery (OR = 4.20 [1.54-11.46], p = 0.005) were associated with VD. Acute urinary retention concerned 4.7% of the population and all were resolved after 6weeks postoperatively. We reported 0.3% of de novo urgency and patients without VD showed a significant decrease of their voiding time at 1year. The placement of RP-TVT without intraoperative tightening seems to be a safe technique ensuring a high cure rate and low occurrences of bladder outlet obstruction.

Overview of Surgical Management of Urinary Incontinence

Overview of Surgical Management of Urinary Incontinence

Effect of Electro-Stimulation in Management of Fecal Incontinence Post Colorectal Surgery

Effect of Electro-Stimulation in Management of Fecal Incontinence Post Colorectal Surgery

Experiences and management of urinary incontinence following treatment for prostate cancer: Disrupted embodied practices and adapting to maintain masculinity.

This article explores men's experiences of and management strategies for urinary incontinence (UI) following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored their post-treatment experiences. Drawing on a conceptual toolkit connecting theories of masculinities, embodiment, and chronic illness, this paper identifies older men's experiences and strategies for managing UI and explores how these are shaped by their masculinities. This article identifies interdependence between managing stigma for UI and maintaining masculinity. Men's embodied practices for engaging in activities in public, crucial to masculine identity, were disrupted. In response, they adopted new reflexive body techniques to manage and resolve their UI, and thereby address the threat to their masculine identities, characterised in three strategies: monitoring, planning, and disciplining. The new embodied practices men described suggest three factors as important components for adopting new reflexive body techniques: routine, desire, and unruliness.

Practitioner's knowledge, attitudes, beliefs and practices towards urinary incontinence.

One in three women in South Africa suffer from urinary incontinence. Effective management is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. Current practice towards urinary incontinence management in South Africa is unknown. Our study aimed to describe and compare urinary incontinence practice and knowledge of nurses and physicians (practitioners) working in primary healthcare settings, measured against the NICE 2013 guideline and explore attitudes and beliefs towards urinary incontinence management. Cross-sectional study using a self-designed online questionnaire. All primary healthcare practitioners in the Western Cape were eligible for the study. Stratified random and snowball sampling was used. Data was analysed in consultation with a statistician using SPSS. Fifty-six completed questionnaires were analysed. Practitioners had an overall knowledge score of 66.7% and practice score of 68.9% compared to NICE 2013 guidelines. A lack of knowledge regarding urinary incontinence screening, following up on patients and conducting bladder diaries were noted. Pelvic floor muscle training and bladder training education was recognised as initial management but only 14.8% of practitioners referred patients to physiotherapy. Half of the sample reported being uncomfortable with urinary incontinence, although the majority wanted to learn more about urinary incontinence. The knowledge and practices of practitioners working at a primary healthcare level in the Western Cape are not congruent with NICE 2013 guidelines. Data can be used to inform intervention planning to address urinary incontinence management at a primary healthcare level in the Western Cape.

The role of menopause hormone therapy in the management of urinary incontinence

Urinary incontinence (UI) is a common problem whose prevalence increases in the post reproductive phase. It can have a significant impact on a woman’s quality of life, her overall well-being and her ability to function normally. The two commonest types of UI are overactive bladder (OAB) and stress incontinence (SUI). The treatment will depend on the underlying pathophysiology but all treatment pathways include a variety of potential interventions such as Pelvic Floor Muscle training. Underpinning all this is the impact of urogenital atrophy which results in changes to the integrity and function of vaginal and urogenital structures and also to the vaginal and urogenital microbiome. This talk focuses on the role of MHT in urinary incontinence.

Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success.

Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.

The Pelvic Surgeon

Journal of Gynecologic SurgeryVol. 39, No. 3 EditorialFree AccessThe Pelvic SurgeonMitchel S. HoffmanMitchel S. Hoffman—Mitchel S. Hoffman, MD, Editor-in-Chief Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA.Search for more papers by this authorPublished Online:1 Jun 2023https://doi.org/10.1089/gyn.2023.0035AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail At the turn of the 20th century, a number of advances made surgery much safer for patients. These were: antisepsis; anesthesia; and eventual introduction of antibiotics and blood banking. Formal surgical training in the United States began in the early part of that century. Expertise in gynecologic surgery in the United States also arose from and in tandem with general surgery. The American Board of Obstetrics and Gynecology was established in 1930 as departments of obstetrics and gynecology continued to develop and expand their training programs. Eventually, training in gynecologic surgery became distinct from that of general surgery. Surgical specialization (including gynecologic) followed, a trend that continues in parallel with advances in medical knowledge and complexity.The pelvis is a confined space where portions of the urinary, genital, and intestinal tracts become intimately associated. For that reason, diseases and other abnormalities in the pelvis may involve multiple organ systems and other neurovascular structures. Therefore, urology, gynecology, and colorectal surgery may all be involved in procedures within the confines of the pelvis. As pelvic diseases and abnormalities cross organ systems and disciplines, so must their surgical management.There are ranges of expertise within each pelvic surgical discipline and, while a multidisciplinary approach may be required at times, the gynecologic surgeon must be able to manage the treatment of extended pelvic disease or related pelvic disorders. In some instances, the various surgical disciplines have developed specialty-specific methodology for managing similar conditions. For the reasons described, pelvic surgery by its very nature is multidisciplinary.Two articles in the current issue address gynecologic surgical management of disease extension or related disorders. Drs. Simone Fertel (MD) and Katie Propst (MD), from the University of South Florida Morsani College of Medicine, in Tampa, FL, USA, discuss the historical background of assessment and management of fecal incontinence and the surgical treatment options for patients who suffer with this condition. The Mayo Clinic's (Rochester, MN, USA) gynecologic oncology division investigated specific procedures that might be associated with postoperative complications occurring with ovarian cancer cytoreductive surgery, and identified the contribution of some nongynecologic procedures. Most importantly, surgery must always be done by appropriately trained and skilled individuals. There is a critical consequence arising from the issues that face surgical training competency, particularly as it affects general gynecologic surgery. General gynecologic surgery especially is in danger of becoming boxed into an increasingly narrower scope of capability. Our specialty must train individuals to be pelvic surgeons. I would be most interested in hearing from you, the readers of this journal, regarding your thoughts on the future of general gynecologic surgery. The best format for doing this would be a Letter to the Editor.FiguresReferencesRelatedDetails Volume 39Issue 3Jun 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Mitchel S. Hoffman.The Pelvic Surgeon.Journal of Gynecologic Surgery.Jun 2023.107-107.http://doi.org/10.1089/gyn.2023.0035Published in Volume: 39 Issue 3: June 1, 2023PDF download

Treating and Managing Urinary Incontinence: Evolving and Potential Multicomponent Medical and Lifestyle Interventions.

Incontinence is defined by either ICS 2002 or IUGA/ICS 2010 as the involuntary loss of urine and includes urgency urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). It has a high worldwide prevalence with an associated impact on quality of life. Despite existing management options for the management of urinary incontinence, patients continue to be troubled by symptoms or side effects of existing treatment. There is therefore a requirement for ongoing research into treatment options for the management of UUI and SUI, that are more effective and tolerable to patients. Advances in treatment of UUI include a more selective beta 3 agonist, Vibegron, which has less impact on cardiac function than Mirabegron. Hormonal treatment, including Ospemifene and Prasterone, may improve GSM and in turn symptoms of UUI. There are advances in the types of neuromodulators available, including those that are rechargeable at home and are MRI safe. Laser has shown promising initial results. There is developing interest in the microbiome, and how this may impact future treatment modalities. Advances in treatment of SUI include the use of mobile health applications to support delivery of pelvic floor muscle training. Litoxetine, a selective serotonin reuptake inhibitor, has shown promising results at phase III trials. Functional magnetic stimulation is being developed to improve contractility of pelvic floor muscles. We also discuss interventions that improve tissue elasticity and regeneration, such as platelet rich plasma, autologous stem cell transplantation, laser therapy and radiofrequency treatment, which show short term benefits.

Duloxetine Use in the Management of Stress Urinary Incontinence &amp; Students’ Survey

The goal of this study is to assess the knowledge and opinion of students regarding the off-label use of duloxetine in the treatment of stress urinary incontinence (SUI). The Survey questions were provided during the Drug Information Course at Howard University (HU) College of Pharmacy in a class where first-year pharmacy students learn how to conduct a literature search and a survey. A total of 39 students responded to the survey. There were more females (n=23; 56.1%) with an age range between 18 – 24 years. About two-thirds (n=29; 70.7%) had a four-year degree before starting the pharmacy program. Overall, participants scored less than the passing 70% mark on the knowledge questions, which may call for educators to make a special effort to incorporate off-label and approved indications of medication teaching therapeutic-related courses. For example, more than sixty percent of respondents (n=25; 61%) incorrectly stated that duloxetine is a narrow therapeutic drug. The majority (n=; 34; 82.9%) of the participants responded wrongly that urinary incontinence is more common in women during their childbearing age. The opinion survey showed that most participants (n=25; 61%) did not believe there were many FDA-approved effective drugs for treating SUI. Over sixty percent of participants (n=25; 61%) considered SUI a severe illness and did not agree to use a non-approved drug such as duloxetine, although several published clinical studies support its effective use. Participants were split in their opinion regarding the non-approved use of medications. Study results suggest that students may need encouragement to explore medications with non-FDA approvals.

(109) Transdermally Powered, MRI Conditional Pump-in-Reservoir Implant Inflator System: Preclinical Studies

Abstract Introduction Inflatable medical implants have been used in the treatment of erectile dysfunction and both urinary and fecal incontinence. However, commercially available devices have required manual operation, which present difficulty in their use for patients lacking strength and dexterity to use such pumps. In women with urinary incontinence, anatomical constraints limit the use of manually operable inflatable devices. Objective The aim of this study was to conduct preclinical testing of a wirelessly powered inflatable medical implant system consisting of a medical provider software application, a patient external controller, and a magnetic resonance imaging (MRI)-conditional nonferrous pump-in-reservoir implant system. Methods An inflatable medical implant system was designed and tested. Serial prototypes designs included a nonferrous, reservoir-submerged package containing electronic motor and pump with piezoelectric valves, and an external controller resembling a TV remote. The implant system was evaluated after being connected to commercially available penile prosthetic cylinders. Power settings were tested at various thresholds; testing requirements considered to be clinically applicable were set as fluid transfer of 60 ml of normal saline at 25 psi within 45 seconds. The effectiveness of power transmission across the human abdominal wall was tested using an interface of a steak slab placed between the external controller and the implant system. Results Device testing at 24 and 36 volts determined that the latter was more efficient and afforded a smaller motor and pump package. Full penile cylinder inflation was recorded at 23 seconds. Effective power transmission was demonstrated across steak slabs. Conclusions A nonferrous pump-in-reservoir medical implant inflator system for penile prostheses is legitimate. It offers an improvement over manually operated inflatable devices, and because it eliminates a manual pump component there is feasibility of constructing a modified device for fluid transfer of urethral cuffs for treating urinary incontinence in men and women. The pump package within the reservoir is advantageous as a heatsinking feature that may limit implant overheating. Finally, the device design without ferrous components affords MRI compatibility. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Novartis