Penile Clamp Research Articles

Narrative patent review of penile clamp, artificial urinary sphincter, and sling innovation in the management of male stress urinary incontinence.

Stress urinary incontinence (SUI) is the involuntary loss of urine affecting 1-3% of the male population. To manage leakage, patients may try a plethora of penile clamps. and may even consider artificial urinary sphincters (AUS) or sling implantation. We aimed to synthesize the evolution of the modern clamp, AUS, and sling through a comprehensive patent search. Patents were found through the databases of United States Patent and Trademark Office (USPTO), GooglePatents, and the World Intellectual Property Office Patentscope, covering patents published through January 6, 2024. We found 30 different patents (10 clamps, 13 AUS, and 7 slings), including the patents pertaining to the functionalities and design of five commercially available penile clamps, the American Medical System 800 (AMS 800), the InVance, AdVance, AdVance XP, and Virtue Slings. The clamps, spanning back to 1938 with Bard Cunningham's clamp, have undergone significant refinements. For example, inventors such as Edson S. Outwin and Juan F. V. Wiesner, have modified the location of the primary pressure point. Accessibility has also improved with inventors, such as Gerald French and John W. Timmons, fastening the clamps with Velcro®, as opposed to the screw and ratchet catch closing mechanism, as in Cunningham's clamp. Similarly, the AUS has greatly evolved since Foley's 1947 "Artificial Sphincter and Method", which was the primary AUS precedent to Mark Polyak's AUS invention, which covered the essential elements and functionalities, such as the incorporation of a balloon reservoir, for the AMS 800. In addressing AUS limitations, inventors such as David W. Anderson and Louisa Thomas have created non-hydraulic AUSs. Likewise, the male sling has seen an evolution in the method of securement, from the use of fixed bone anchors in the InVance sling to the transobturator route used in the AdVance XP, avoiding bone complications. Additionally, innovation in sling adjustment of urethral compression allows for adjustable urethral elevation and distal compression respectively. Recent patents have claimed technological integration for clamps, AUS, and slings, especially concerning automation. Overall, patents have built upon the limitations of previous devices. However, there is still a need to innovate for increased clamp comfort and reduced reoperation rates for the AUS and sling.

Patients experience with the use of a penile clamp in post-prostatectomy incontinence - a prospective pilot study.

The aim of this study was to assess the efficacy of a penile clamp in managing urinary incontinence (UI) and its impact on perceived quality of life (QoL) amongst post-prostatectomy patients. A prospective pilot study was conducted including patients with post-prostatectomy UI treated with a penile clamp. Inclusion criteria consisted of UI after radical prostatectomy, good hand function, full cognitive function and a minimum penile length of 3 cm and a circumference of 5 cm. An appropriately sized penile clamp was selected during the first visit, and patients were given instructions on how to use it. The first follow-up was a scheduled phone call 1 week after the initial visit. Formal evaluations were performed prior to use of the penile clamp and again after 3 months of usage. These consisted of weighing pads during the daytime with evaluation of leakage, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), incontinence-QoL (I-QoL) and a questionnaire specific for the penile clamp. There were 22 patients included, and two were excluded due to reduced hand function and surgery before the study endpoint. The results showed a significant median reduction of urinary leakage of 57% at rest and 58% during physical activity. One complication was observed, as one patient developed a pinching ulcer, after extensive usage. ICIQ-SF showed an increase of 6% for the included patients (n = 20). Ten patients were satisfied with the clamp, and 15 would recommend the clamp to others. The penile clamp shows promising results in reducing leakage with minimal risks of complications. It can be used as a treatment for patients awaiting surgery. However, patient selection is important regarding hand function, cognitive function and the penile anatomy.

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.

Utility of a penile compression device for the quality of life in male patients with urinary incontinence after prostatectomy (the MORE study): a randomized prospective study

ObjectivesTo verify the effects of penile clamping on the degree of stress urinary incontinence and quality of life in post-radical prostatectomy patients.ResultsThirty-seven patients suffering from stress urinary incontinence after undergoing radical prostatectomy were enrolled. A total of 19 and 18 patients were analyzed in the non-clamp and clamp groups, respectively. The mean ages of the patients in non-clamp and clamp groups were 68.3 ± 7.1 years and 71.2 ± 4.8 years, respectively; the mean time after radical prostatectomy was 28.9 ± 44.0 months and 26.2 ± 39.0 months, respectively. The penile clamp used was the CLAMPMED® (URINE CONTROL CLAMP) size M (MURANAKA MEDICAL INSTRUMENTS Co., Ltd.). Specific urinary care pads (Sawayaka Pad for Men, Small Quantity®, Unicharm Corporation), were provided; the average daily usage was monitored for four weeks. The quality of life was evaluated using the King’s Health Questionnaire. The average daily use of urinary care pads was significantly reduced in the clamp group than in the non-clamp group (-0.83 ± 1.51 vs. -0.16 ± 0.69, P = 0.0071). King’s Health Questionnaire scores did not change significantly in either group. Wearing the CLAMPMED® reduced the amount of urinary incontinence but did not improve the quality of life.Trial registrationThe Japan Registry of Clinical Trials (jRCT1052230083). Registered 2 August, 2023.

The Evolution of Management of Male Stress Urinary Incontinence

Introduction: The struggle to treat male stress urinary incontinence (SUI) dates back centuries, with descriptions of male urinary incontinence (UI) in Egyptian manuscripts as early as 1500 BCE. In this review, we chronicle the history of male SUI interventions that have educated the modern options available today. Sources and Methods: A comprehensive literature review was performed to elucidate relevant historical and clinical information. We used PubMed to identify contemporary medical literature at www.ncbi.nlm.nih.gov and JSTOR, the digital library, to access archived, older texts at www.jstor.org. Results: French surgeon Ambroise Paré is credited with developing the first portable urinals in 1564, which was quickly followed by Hildanus developing the condom catheter and penile clamp in the 1600s. The first documented compression device was developed by Lorenz Heister in 1747. Two hundred years later, Frederic Foley created a urinary sphincter and in 1973, F. Brantley Scott created the first multi-component artificial urinary sphincter (AUS). In the 1960s and 1970s, mesh implants 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 male UI are evolutionary byproducts of centuries of experimental designs by pioneering surgeons from around the world. While the materials have improved, barrier, storage devices and bulking agents almost identical to the versions first invented remain in use today.

Ten-year treatment complication outcomes of radical prostatectomy vs external beam radiation vs brachytherapy for 1503 patients with intermediate risk prostate cancer

To compare 10-year late complications of radical prostatectomy (RP) versus external-beam-radiation-therapy (EBRT) versus brachytherapy (BT). Retrospective analysis was performed on 1503 intermediate-risk-prostate-cancer patients treated from 2004 to 2007, using univariate comparisons. Eight hundred and nineteen underwent RP, 574 EBRT, and 110 BT. RP urinary and rectal complications were graded severe if patients required ≥3 pads/diapers per day, chronic condom catheter or penile clamp, daily clean-intermittent-catheterization, sling, artificial-urinary-sphincter, or rectal fistula. Complications for EBRT/BT were severe if graded 3/4 on the Radiation-Therapy-Oncology-Group scale for late effects. The prevalence of erectile-dysfunction-devices (EDD) of injections, pumps and/or penile implants were compared. Median follow-up for RP versus EBRT versus BT were 10.0, 9.6, and 9.8 years. Median age were 62.1, 70.8, 65.3, p < 0.0001. The 10-year prevalence of severe urinary complications for RP versus EBRT versus BT were 10.1%, 12.5%, 4.6%, p = 0.03, and were less for RP <64 years, p = 0.03, and lower Charlson score, p = 0.05. Pretreatment American-Urological-Association (AUA) score existed for 7.3%, 11.5%, 97.3% of RP versus EBRT versus BT, p < 0.0001, and the 10-year prevalence of EDD were 24.3%, 6.6%, 8.2%, respectively, p< 0.0001. Severe rectal complications were slightly higher for EBRT, p = 0.06. BT had lower prevalence of severe urinary complications, possibly by using AUA score to avoid patients with obstructive uropathy. Urinary complications may be reduced by limiting RP to younger, healthier patients, and by avoiding EBRT/BT with obstructive symptoms. RP had higher prevalence of EDD, despite having younger, healthier patients.

Investigation of Triamcinolone Instillation in the Long-term Rate of Anterior Urethral Strictures' Recurrence

Background/Aims: Previous publications confirmed that after internal urethrotomy success rates in the short-term (less than 6 months) are varied (70-80%) and in the long-term results are generally low. In this study, the efficacy of triamcinolone instillation based on a newly introduced protocol on the rate of recurrence in patients with anterior urethral strictures was evaluated. Methods: A total of 66 patients were divided into treatment group (n = 33), in which triamcinolone was instilled on urethra after removing of Foley catheter and control group (n = 33) that not received any intervention. Each 40 mg/1 ml of triamcinolone vial was dissolved in 9 ml of distilled water and then a 2 ml of diluted solution was used for each instillation and 8 ml was kept in 4°C. Triamcinolone was instilled based on daily in week 1, every other day for week 2 and then every Monday and Friday for 2 months. Penile clamp was used after instillation for 1 hour. Treatment failure was based on urine flow rate, rate of recurrence and time to appearance of recurrence. Results: There were not any significant differences regrading to age (p = 0.09), length (p = 0.41) and diameter (p = 0.36) of stricture between 2 groups. Time to appearance of recurrence showed significantly in the treatment group when compared with that in the control group (1,350 ± 900 vs. 124.3 ±112 days; p < 0.01). In the treatment group, 88% had reasonable consequence, while in control 48%. There were 3 patients with a mean length-diameter of stricture around 0.3-5 cm who showed recurrence free with the mean of 720 days after intervention. Conclusion: Administration of triamcinolone instillation in urethra is associated with a decreased risk of stricture recurrence. Superior outcomes were seen in patients with a stricture length of more than 2 cm and this may in part reflect the increasing efficacy of the instillation method in the management of urethral strictures. These findings help identify patients with aggressive features of strictures in urethra who may benefit from intensified treatment efficacy of triamcinolone instillation.

Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence.

Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions. We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns. Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps. Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.

Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series

Background: Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases. Methods: Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state. Results: The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp. Conclusions: MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage. Level of evidence: 4

FR02-05 THE EVOLUTION OF MANAGEMENT OF MALE URINARY INCONTINENCE

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.

&lt;p&gt;Tissue response to applied loading using different designs of penile compression clamps&lt;/p&gt;

Background: Penile compression devices (PCD) or clamps are applied to compress the urethra and prevent urinary incontinence (UI). PCDs are more secure and less likely to leak than pads, allowing men the opportunity to participate in short-term, vigorous activities. However, they are uncomfortable, can cause pressure ulcers (PU) and affect penile blood flow. No objective assessment of tissue health has been undertaken to assess and compare different PCD designs and to provide guidance on safe use.Objective: This study was designed to evaluate existing PCDs in terms of their physiological response and potential for pressure-induced injury.Design, setting and participants: Six men with post-prostatectomy UI tested four selected PCDs at effective pressures, in a random order, in a controlled laboratory setting.Outcome measurements and statistical analysis: Using objective methods for assessing skin injury, PCDs were measured in situ for their effects on circulatory impedance, interface pressures and inflammatory response.Results and limitations: There was evidence for PCD-induced circulatory impedance in most test conditions. Interface pressures varied considerably between both PCDs and participants, with a mean value of 137.4±69.7 mmHg. In some cases, penile skin was noted to be sensitive to loading with elevated concentration of the cytokine IL-1α after 10 mins wear, indicating an inflammatory response. IL-1α levels were restored to baseline 40 mins following PCD removal.Conclusion: Skin health measures indicated tissue and blood flow compromise during the 50 mins of testing using all PCDs. Although there was an elevation in pro-inflammatory cytokines, PCDs did not cause sustained irritation and skin health measures recovered 40 mins after PCD removal. This research indicates that application of a clamp for one hour with an equal clamp free time before reapplication is likely to be safe. Longer periods are often recommended by manufacturers but have yet to be tested.

Ten year treatment complication outcomes of radical prostatectomy versus external beam radiation therapy versus brachytherapy for 1,503 patients with intermediate risk prostate cancer.

e16599 Background: To compare 10 year treatment complication outcomes of radical prostatectomy(RP) vs external beam radiation therapy(EBRT) vs brachytherapy(BT) for patients with intermediate risk prostate cancer(IRPC). Methods: A retrospective analysis was performed on 1,503 IRPC patients who underwent treatment from 2004 to 2007, using univariate comparisons. 819 underwent RP, 574 underwent EBRT, and 110 underwent BT using iodine-125. Urinary and rectal complications for RP were graded as severe if patients required ≥ 3 pads/diapers per day, required chronic use of condom catheter or penile clamp, daily self-catheterization, placement of sling or artificial urinary sphincter, or developed rectal fistula/incontinence. Complications for EBRT and BT were graded as severe if they were classified as grade 3 or 4 on the Radiation Therapy Oncology Group grading system for late effects. For erectile dysfunction, the prevalence of patients requiring injections, pumps or penile implants were calculated after a minimum of 1 year of follow up. Results: Median follow up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% for RP patients vs 58.9% of EBRT vs 12.7% of BT, p &lt; 0.0001. Median age for RP vs EBRT vs BT was 62.1, 70.8, 65.3, p &lt; 0.0001. The 10-year prevalence of severe urinary complications for RP vs EBRT vs BT was 10.1%, 12.5%, 4.6%, p = 0.04. The percentage of patients having a pre-treatment American Urological Association(AUA) urinary score for RP vs EBRT vs BT was 7.3%, 11.5%, 97.3%, p &lt; 0.0001. The 10-year prevalence of severe rectal complications for RP vs EBRT vs BT was 0.5%, 1.6%, 0.0%, p = 0.06. The 10-year prevalence of erectile dysfunction devices for RP vs EBRT vs BT was 24.3%, 6.6%, 8.2%, p &lt; 0.0001. Conclusions: After 10 years of follow-up, BT had the lowest rate of severe urinary complications, which may due to using the AUA score to avoid implanting those who had significant baseline obstructive voiding symptoms. EBRT had a higher rate of severe rectal complications. RP had the highest probability of undergoing treatment using erectile dysfunction devices, despite having younger patients.

Ten year treatment complication outcomes of radical prostatectomy versus external beam radiation therapy versus brachytherapy for 1,503 patients with intermediate risk prostate cancer.

67 Background: To compare 10 year treatment complication outcomes of radical prostatectomy(RP) vs external beam radiation therapy(EBRT) vs brachytherapy(BT) for patients with intermediate risk prostate cancer(IRPC). Methods: A retrospective analysis was performed on 1,503 IRPC patients who underwent treatment from 2004 to 2007, using univariate comparisons. 819 underwent RP, 574 underwent EBRT, and 110 underwent BT using iodine-125. Urinary and rectal complications for RP were graded as severe if patients required ≥ 3 pads/diapers per day, required chronic use of condom catheter or penile clamp, daily self-catheterization, placement of sling or artificial urinary sphincter, or developed rectal fistula/incontinence. Complications for EBRT and BT were graded as severe if they were classified as grade 3 or 4 on the Radiation Therapy Oncology Group grading system for late effects. For erectile dysfunction, the prevalence of patients requiring injections, pumps or penile implants were calculated after a minimum of 1 year of follow up. Results: Median follow up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% for RP patients vs 58.9% of EBRT vs 12.7% of BT, p &lt; 0.0001. Median age for RP vs EBRT vs BT was 62.1, 70.8, 65.3, p &lt; 0.0001. The 10-year prevalence of severe urinary complications for RP vs EBRT vs BT was 10.1%, 12.5%, 4.6%, p = 0.04. The percentage of patients having a pre-treatment American Urological Association(AUA) urinary score for RP vs EBRT vs BT was 7.3%, 11.5%, 97.3%, p &lt; 0.0001. The 10-year prevalence of severe rectal complications for RP vs EBRT vs BT was 0.5%, 1.6%, 0.0%, p = 0.06. The 10-year prevalence of erectile dysfunction devices for RP vs EBRT vs BT was 24.3%, 6.6%, 8.2%, p &lt; 0.0001. Conclusions: After 10 years of follow-up, BT had the lowest rate of severe urinary complications, which may due to using the AUA score to avoid implanting those who had significant baseline obstructive voiding symptoms. EBRT had a higher rate of severe rectal complications. RP had the highest probability of undergoing treatment using erectile dysfunction devices, despite having younger patients.

Low grade transitional cell carcinoma of the urethra successfully treated with only intraurethral instillation of Mitomycin-C

Urethral cancer is very rare disease, accounting for less than 0.5% of incidences of malignancies. Data on its management are scarce due to the rare nature of the cases. We present a 34-year-old man, who presented to our hospital with a month history of hematuria. He had no lower urinary tract symptoms and no significant risk factors for urothelial cancer. He was evaluated and found to have lesions in the posterior urethra on urethrocytoscopy, biopsy of which revealed a low-grade urothelial cancer. He was counselled and had 6 courses of intraurethral instillation of 40mg of Mitomycin-C diluited in 50mL of saline held in the urethra with penile clamp for 30 minutes. The hematuria stopped after the second course, a repeat urethrocystoscopy 6 months after the completion of the chemotherapy, showed resolution of the lesion and repeat biopsy showed no evidence of malignancy. However, the patient developed short segment partial penile urethral stricture that was treated with dilatation. In conclusion, low-grade urothelial cancer of the urethra can be successfully cured with Intraurethral instillation of Mitomycin-C, without prior transurethral resection.

Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence.

In severe post-prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson-Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H2 O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post-prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H2 O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.

Conservative Management of Male Stress Urinary Incontinence

Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter. This review contains 3 figures and 54 references Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence

Conservative Management of Male Stress Urinary Incontinence

Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter. This review contains 3 figures and 54 references Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence

A historical perspective and evolution of the treatment of male urinary incontinence.

To describe the historical changes from antiquity until present in the presentation and treatment of male urinary incontinence. A literature review of PubMed articles in English pertaining to male incontinence was performed. Male urinary incontinence was first mentioned in Egyptian manuscripts in 1500 B.C. In 1564, Ambroise Pare designed portable urinals for incontinent males. Wilhem Hildanus created the first condom catheter with pig bladder in the 1600s and was also credited with fashioning the first penile clamp. Lorenz Heister introduced a perineal bulbar urethral compression belt in 1747 which would provide the blueprint for air-inflated bulbar urethral compression devices such as the one designed by S.A. Vincent in 1960. Robert Gersuny performed the first periurethral paraffin injection bulking therapy in the late 19th century. In 1929, Frederic Foley introduced the modern catheter, and also credited with conception of the first artificial sphincter. From 1970 to 1973, Joseph Kaufman surgically created bulbar compression for post-prostatectomy incontinence, but not before designing the first male sling with John Berry in 1958. In 1973, F. Brantley Scott introduced the first multi-component artificial inflatable sphincter. Improvements upon periurethral bulking therapy occurred rapidly in the late 20th century with Teflon, collagen, autologous adipose, tissue and cross-linked silicone gels. Since 2007, stem cell injection therapy has emerged as a new therapeutic option for incontinence; however, results are mixed and remains experimental. Treatment for male urinary incontinence has evolved from noninvasive devices to various surgical procedures. Artificial sphincters remain the gold-standard therapy for male urinary incontinence.

MP52-04 A NOVEL USE OF METHYLENE BLUE IN ANTERIOR URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2016MP52-04 A NOVEL USE OF METHYLENE BLUE IN ANTERIOR URETHROPLASTY Sanjay kulkarni, Pankaj Joshi, Sandesh Surana, Atef Homuda, and Jyotsna Kulkarni Sanjay kulkarniSanjay kulkarni More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Sandesh SuranaSandesh Surana More articles by this author , Atef HomudaAtef Homuda More articles by this author , and Jyotsna KulkarniJyotsna Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.480AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of methylene blue (MB) to highlight anatomic structures in Urology is a well-established practice. A narrow urethral plate can be difficult to properly locate intraoperatively, particularly in Panurethral strictures. Our objective is to assess the value of intraurethral injection of MB during urethroplasty. METHODS 5 cc of MB (10mg/ml) is diluted in 10 cc of normal saline. The MB is gently injected retrograde into the urethra. A penile clamp is applied for 5 minutes to increase the contact time of the MB with the urethra. The urethroplasty commenced and the urethra was opened. The impact of the MB on the anatomy of the urethra was by subjective assessment of a single surgeon (S.B.K.). RESULTS 492 consecutive cases were prospectively evaluated from 2010-2014. Precise staining of the narrow lumen was successfully observed in 464 (94%). In these 464 cases, the diseased urethral strictured portion of the urethra was stained blue with MB. The grossly normal appearing urothelium remained pink and did not take up significant MB stain. Both stained and unstained mucosa was sent for histopathology examination in representative 20 patients. Blue stained urethra showed evidence of stricture in all patients. Unstained samples showed normal urethra. In 28 (6%) cases minimal or no staining was observed. Extravasation in to the spongiosa was seen in 8 (2%) cases. In 22 (4%) cases there was dense staining distal to the narrow lumen. There were no known allergic complications. CONCLUSIONS Normal urothelium does not absorb urine or water, and dilute MB flows over normal epithelium without staining. MB readily stains diseased and strictured urothelium. Intraurethral injection of MB is a useful tool in urethroplasty. It helps in delineation of stricture and identifying lumen. It guides us to the exact area of urethra to be augmented which has been corroborated with histopathology. It is a simple, non-costly and non-invasive tool. In our high volume tertiary referral unit, it is now standard to inject methylene blue in urethra immediately prior to urethroplasty. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e690 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sanjay kulkarni More articles by this author Pankaj Joshi More articles by this author Sandesh Surana More articles by this author Atef Homuda More articles by this author Jyotsna Kulkarni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Male urethral diverticulum uncommon entity: Our experience

Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall. Case 2A: 30 year male with obstructive lower urinary tract symptoms (LUTS). Retrograde urethrogram (RGU) revealed bulbar urethral diverticulum akin to anterior urethral valve, managed endoscopically. 1 year follow up urine stream satisfactory. Case 3A: 27 year male previously operated large proximal bulbar urethral stone with incontinence. RGU large proximal bulbar UD with wide open sphincter. Treated with excision of excess diverticular wall and penile clamp with pelvic exercises for incontinence. Congenital UD develops due to imperfect closure of urethral fold, Acquired UDs occurs secondary to stricture, infection, trauma, long standing impacted urethral stones or scrotal / skin flap urethroplasties. RGU and MCU are the best diagnostic technique to confirm and characterize the UD. Urethral diverticulectomy with urethral reconstruction is the recommended treatment for UD. UD is a rare entity. Especially in males, congenital are even more rare. Management should be individualized. Surgery can involve innovation and/or surgical modifications. We used excess diverticular flap for stricture urethroplasty in one case.