Treatment Of Male Urinary Incontinence Research Articles

A modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for male stress urinary incontinence: a pilot study.

The aim of this study was to demonstrate the feasibility of a modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence and to preliminarily evaluate the short-term clinical efficacy of this technique. The clinical data of patients treated with the modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique using a Pelvimesh pelvic floor repair patch as a sling were collected. The primary evaluation criteria were surgery-related indicators and daily urinal pad usage before and after treatment, and the secondary evaluation criteria were the corresponding incontinence scores and the results of surgery-related questionnaires. After 1-12months of follow-up, seven patients were clinically cured. Follow-up 1 month after surgery showed that one patient (14.3%) used one pad daily, and six patients (85.7%) did not need pads. The incontinence quality of life questionnaire (I-QOL) scores at 3 days and 1 month postoperatively were 89.4 ± 2.5 and 88.1 ± 6.7, respectively, which were significantly higher than the preoperative scores (31.5 ± 18.9) (P < 0.05). The scores of the International Continence Control Association Incontinence Questionnaire Short Form (ICI-Q-SF) at 3 days and 1 month postoperatively were 3.2 ± 0.9 and 4.2 ± 1.7, respectively, which were significantly lower than the preoperative scores of 19.4 ± 5.0 (P < 0.05). In addition, the results of the surgery-related questionnaires were positive. No serious complications occurred in any of the patients. The modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence patients is safe, effective, minimally invasive, and has few complications. However, further validation in large sample, randomized, comparative, and longer-term follow-up studies is still needed.

Physiotherapy as an Effective Method to Support the Treatment of Male Urinary Incontinence: A Systematic Review.

Urinary incontinence (UI) is a serious health issue that affects both women and men. The risk of UI increases in men with age and after treatment for prostate cancer and affects up to 32% of men. Furthermore, UI may affect up to 69% of men after prostatectomy. Considering such a high incidence, it is critical to search for effective methods to mitigate this issue. Hence, the present review aims to provide an overview of physiotherapeutic methods and evaluate their effectiveness in treating UI in men. This systematic review was performed using articles included in PubMed, Embase, WoS, and PEDro databases. A total of 6965 relevant articles were found. However, after a risk of bias assessment, 39 studies met the inclusion criteria and were included in the review. The research showed that the available physiotherapeutic methods for treating men with UI, including those after prostatectomy, involve pelvic floor muscle training (PFMT) alone or in combination with biofeedback (BF) and/or electrostimulation (ES), vibrations, and traditional activity. In conclusion, PFMT is the gold standard of UI therapy, but it may be complemented by other techniques to provide a personalized treatment plan for patients. The effectiveness of the physiotherapeutic methods varies from study to study, and large methodological differences make it difficult to accurately compare individual results and draw unequivocal conclusions.

Long-term Functional Outcomes and Patient Satisfaction After AdVance and AdVanceXP Male Sling Surgery

BackgroundTransobturator male sling has gained increasing acceptance for the treatment of male urinary incontinence. Several prospective trials have demonstrated the safety and efficacy of the AdVance and AdVanceXP slings. ObjectiveTo evaluate long-term functional outcomes after AdVance or AdVanceXP sling implant for non-neurogenic male stress urinary incontinence and identify factors associated with a higher risk for incontinence or decreased satisfaction. Design, setting, and participantsPatients who underwent AdVance or AdVanceXP implant surgery between June 2007 and April 2018 were retrospectively included in this single-institution, consecutive series. Outcome measurements and statistical analysisIn April 2020, patients were recontacted to evaluate long-term functional outcomes and satisfaction by standardized, validated questionnaires. Results and limitationsA total of 216 patients were included in this study; 172 of them could be contacted for the assessment of long-term patient reported outcomes. The median follow-up period was 49 mo. Overall social continence (ie, needing no more than one pad per 24 h) at 5-yr follow-up was 66% (confidence interval [CI]: 58–73%). In an ideal population (ie, needing no more than four pads per 24 h and naïve for pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery), 5-yr social continence rates were markedly better and reached 79% (CI: 69–85%). Overall social continence rates tended to decrease at 10-yr follow-up to 42% (CI: 33–52%). Overall, totally dry rate at 5-yr follow-up was 53% (CI: 46–60%), which again was significantly better in the ideal population (62%, CI: 51–70%). According to the Patient Global Improvement Indices score, 71% (CI: 63–78%) of patients indicated to be satisfied after 5 yr, which improved to 77% (CI: 67–85%) in the ideal patient population. In a multivariate analysis, prior pelvic radiotherapy and previous incontinence or urethral stricture surgery were associated with decreased continence rates and patient satisfaction. ConclusionsIn general, long-term continence rates and patient satisfaction after AdVance and AdVance XP sling surgery are acceptable but deteriorate significantly as time from surgery progresses. Especially patients with a history of pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery should be counseled properly about their higher risk for sling failure. Patient summaryIn this report, we investigated long-term outcomes after Advance and AdvanceXP sling implant for male stress urinary incontinence. We found that, in general, continence and patient satisfaction are acceptable but deteriorate significantly as time from surgery progresses. Patients with previous pelvic radiotherapy, incontinence surgery, or urethral stricture surgery are at higher risk for sling failure.

Comparison of penoscrotal and perineal approaches for implantation of an artificial urinary sphincter in man

Artificial urinary sphincter is considered the gold standard of treatment for male urinary incontinence because of intrinsic sphincter deficiency. The objective of our study was to compare the functional results and complications of the penoscrotal and perineal incision for the implantation of artificial urinary sphincter. A retrospective, monocentric study comparing the perioperative and long-term results of primary implantation of an artificial urinary sphincter in men, performed by the penoscrotal or the perineal incision, was conducted in a French university hospital. Between April 2004and February 2019, 175patients were implanted (118by penoscrotal incision and 57by perineal incision) by 19surgeons. Cuff placement approach depended on surgeon preference. The average follow-up was 34.2±35.6months. Cuff size was smaller in the penoscrotal group (4 [4;5] vs 4.5[4;5] p<0.001). At the end of follow-up, the rates of complete continence, social continence, reintervention for any reason, explantation, and revision was similar between the two groups. Long-term outcomes of penoscrotal and perineal artificial sphincter implantation were similar between the two groups. Prospective multicenter studies are needed to confirm these results.

Extended follow-up of the AdVance XP male sling in the treatment of male urinary stress incontinence after 48 months: Results of a prospective and multicenter study.

To evaluate the efficacy and safety of the AdVance XP male sling in a midterm follow-up for the treatment of male urinary incontinence in a selected patient cohort. In all, 115 patients with postprostatectomy incontinence were prospectively enrolled. A previous endoscopic evaluation of a sufficient coaptive zone in the repositioning test was mandatory. Patients with urine leakage in supine position or previous incontinence surgery were excluded. Postoperatively a standardized 24-hour pad test and pad usage were evaluated. To compare pre- and postoperative continence status nonparametric t test was used. A P-value of <.05 was seen as statistically significant. Median preoperative urine loss in the 24-hourpad test was 272 g (min. 42-max. 1600) and was significantly improved at any point in follow-up. Success was defined as 0 pads per day and a maximum of 5 g in the 24-hour pad test. After a follow-up of 48 months, 71.7% of the patients were cured, whereas 15.0% of patients had an improved continence situation and 13.3% were classified as failed. Mean urine loss decreased significantly to 24.4 g (P ≤ .001). No severe intra- or postoperative complications are to be reported. Median follow-up was 4.2 years. A stable effectiveness in a selected patient cohort can also be demonstrated in an extended follow-up. The complication rates are low and no late postoperative complications occurred, indicating the safety of the procedure.

Differentiated surgical treatment of male stress urinary incontinence-between intention and reality?

The differentiated surgical treatment of male urinary incontinence is avery interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently alack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and aconstructive attempt to differentiate the indication.

Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status.

To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.

Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results

The artificial urinary sphincter is a common treatment of male urinary incontinence. We sought to characterize long-term rates of artificial urinary sphincter revision/removal and reimplantation, and associated risk factors. We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent artificial urinary sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of artificial urinary sphincter reimplantation and revision/removal, and identify risk factors, respectively. A total of 1,632 male patients underwent initial implantation of an artificial urinary sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or between community and academic hospitals in terms of revision/removal. A high level of comorbidity was associated with an increasing risk of removal/revision. The reimplantation rate was significantly lower in patients who underwent insertion at hospitals with the highest volume of surgery (HR 0.55, 95% CI 0.37-0.82, p <0.01). A high level of comorbidity was not associated with an increasing risk of reimplantation. Preimplantation radiotherapy was not significantly associated with the risk of reimplantation (p = 0.17) or revision/removal (p = 0.95). Other factors were not significantly associated with reimplantation or revision/removal. Most men who undergo artificial urinary sphincter placement still have a device without repeat surgery 10 years following insertion. Radiotherapy does not increase the risk of repeat surgery. A high level of comorbidity was associated with an increasing risk of removal/revision.

Pirmoji patirtis implantuojant dirbtinį sfinkterį „AMS 800“

TikslasPateikti pirmuosius vyrų šlapimo nelaikymo po radikalios prostatektomijos rezultatus, implantuojant „AMS 800“ dirbtinį sfinkterį. Įvertinti šio metodo efektyvumą ir pranašumą.Medžiaga ir metodai2016 m. lapkričio 4 d. VUL SK Urologijos centre 3 pacientams dėl sunkaus šlapimo nelaikymo, atsiradusio po radikalios prostatektomijos dėl prostatos karcinomos, buvo implantuoti šlapimo pūslės dirbtiniai sfinkteriai „AMS 800“. Šiems pacientams konservatyvus šlapimo nelaikymo gydymas buvo neveiksmingas. Visi pacientai prieš operaciją buvo išsamiai ištirti. Jiems prostatos vėžio progresavimo, šlaplės striktūrų, liekamojo šlapimo nebuvo, šlapimo takų infekcijos nerasta. Pacientai patikrinti praėjus mėnesiui po dirbtinio sfinkterio aktyvavimo.RezultataiIš viso buvo implantuoti 3 dirbtiniai sfinkteriai 3 pacientams. Praėjus 6 savaitėms buvo aktyvuoti 2 sfinkteriai, vieno sfinkterio aktyvuoti nepavyko dėl prietaiso techninių kliūčių, tačiau po 1 savaitės pakartotinis aktyvavimas buvo sėkmingas. Patikrinus 3 pacientus praėjus 1 mėnesiui po sfinkterio aktyvavimo, dviem visiškai nereikėjo įklotų, 1 šlapimo laikymas pagerėjo 60 proc. (anksčiau sunaudojo 6, dabar užtenka 2 įklotų).IšvadosRemdamiesi literatūra ir savo pirmuoju patyrimu galime teigti, kad „AMS 800“ dirbtinis sfinkteris yra laiko patikrintas ir laikomas auksiniu standartu gydant vidutinio ir didelio laipsnio įtampos šlapimo nelaikymą. Tinkamai ištyrus pacientą, pasiekiami geri gydymo ir paciento pasitenkinimo operacija rezultatai, labai pagerėja gyvenimo kokybė.

Comparison of two artifical urinary sphincters for the treatment of male urinary incontinence

Comparison of two artifical urinary sphincters for the treatment of male 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.

Treatment of Male Urinary Incontinence Post–Radical Prostatectomy Using Physical Therapy Interventions

Background: Urinary incontinence (UI) is a likely consequence following radical prostatectomy. Physical therapy interventions for post–radical prostatectomy UI, including pelvic floor muscle (PFM) exercise with the assistance of electromyography biofeedback; behavioral training, including bladder training and urgency suppression techniques to delay voids; and abdominal muscle strengthening exercises are typically recommended to men soon after surgery. The purpose of this case report was to describe the physical therapy management of a male patient with a 10-year history of persistent post–radical prostatectomy bladder symptoms. Study Design: Case report. Case Description: The patient was a 76-year-old man 10 years postprostatectomy with symptoms of urgency and mixed UI. Physical therapy interventions included PFM exercises, behavioral strategies to reduce urinary urgency and frequency and to prevent UI leakage, and bladder training. Outcomes: This patient achieved improved bladder control and enhanced quality of life. Specifically, the International Continence Society Male Short Form (ICSmaleSF) functional questionnaire scores improved, with the largest change (50% improvement) in the Incontinence subscore. In addition, UI quality-of-life impact was endorsed as “not at all” following intervention. The number of UI episodes per day also decreased by 50%, and improvements in PFM function and abdominal strength also occurred. Discussion: This case report illustrates that improvement in bladder control and quality of life is possible well beyond 1 year postprostatectomy with physical therapy interventions.

Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

ObjectiveTo evaluate the safety and efficacy of the “Adjustable Trans-Obturator Male Sling System (ATOMS)” as a new surgical technique for the treatment of different types of male urinary incontinence. Subjects and methodsBetween March 2012 and December 2013, 9 patients with a mean age of 56 (range 15–74) years were operated for urinary incontinence using the ATOMS system. Incontinence had developed following bladder exstrophy repair in 2, after radical cystectomy with construction of an orthotopic neobladder in 3, after transvesical open prostatectomy in one and after radical prostatectomy in 3 patients. Preoperative evaluation included a detailed medical history, physical examination, 24-h pad tests, urodynamic assessment and sonography. ResultsThe mean number of pads used preoperatively was 4.6 (range 3–6). The mean operative time was 45 (range 36–50)min. No intraoperative complications were encountered. The mean hospital stay was 3.8 (range 3–6) days. Transient perineal/scrotal pain was observed in 6 patients (66.7%) and controlled with non-opioid analgesics. There were no perineal infections; however, two port infections occurred (22.2%) and repositioning of the port was done in these cases. At a mean follow-up of 9 (range 6–12) months, the overall success rate was 100% with 77.8% of the patients being completely dry (0 pads per 24h) and 22.2% using less than 2 pads per 24h. ConclusionsOur early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.

Treatment of Male Urinary Incontinence with An Adjustable Implantable Medical Device: Ustrap

Introduction and Objectives: Our aim is to develop a device which is simpler, less expensive, but equally or more effective than currently available devices including the artificial urinary sphincter. Method: Based on our knowledge of and experience with other devices we designed the Ustrap. The theoretical advantages of our approach are described as is the development to the current (3rd) version. Results: For version #1, implanted in 6 patients, the 5 year follow up includes 2 improved, 2 unchanged, 2 required AUS. For version #2 implanted in 4 patients, 2 year follow up shows 3 improved, 1 failure. Conclusions: The Ustrap has unique features which distinguish it from current devices. A proposed multicenter prospective clinical trial of version #3 is awaiting approval.

15 First outcomes of “ZSI 375” urinary sphyncter implantation for the treatment of male urinary incontinence

15 First outcomes of “ZSI 375” urinary sphyncter implantation for the treatment of male urinary incontinence

Effective management in male urinary incontinence.

Effective assessment is key to the effective management of male urinary incontinence. Identification of the specific type of incontinence being experienced by the patient will inform the treatment plan, and the holistic needs of the patient need to be considered before making a decision in this regard. This article describes the different types of male lower urinary tract symptoms and gives recommendations for managing and treating each specific type. It will also consider potential issues surrounding treatment of male urinary incontinence, such as communication issues from the perspective of the health-care professional and the patient themselves, before giving containment strategies and methods.

B35 - First outcomes of implanting Argus® adjustable male sling in treatment of male urinary incontinence

B35 - First outcomes of implanting Argus® adjustable male sling in treatment of male urinary incontinence

An update in the treatment of male urinary incontinence

Male urinary incontinence affects a significant number of elderly men and the successful treatment has the potential to significantly improve their quality of life. Stress urinary incontinence, overflow incontinence and detrusor overactivity are the major categories of urinary incontinence affecting men. Although the surgical standards of care have not changed significantly for urinary incontinence, there have been recent advances with minimally invasive techniques, which show promise. The treatment of male urinary incontinence is constantly evolving, with recent advances in minimally invasive procedures.

Continence Care Literature Review 2012

Continence Care Literature Review 2012

The artificial urinary sphincter is the treatment of choice for post–radical prostatectomy incontinence

In 1973, an innovative implantable surgical device for urinary incontinence was first introduced.1 From the first publication, through the last major modification of the narrow-back cuff design in 1985,2 and up to today the artificial urinary sphincter (AUS) is still the most frequently used and reported surgical treatment for male urinary incontinence. More is known about the AUS than about any other interventional treatment for postprostatectomy incontinence (PPI). Durability, adverse factors, use in elderly patients and revisional surgery are reported extensively.