Aims:To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. Methods: The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Results: Voiding diary and pad tests are valuable for assessing quantity of leakage.Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI.Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Conclusions: Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.
A 53-year-old woman with obesity, hypertension, insulindependent diabetes mellitus and ischaemic vascular disease of lower extremities represented too great a risk for a more invasive procedure than chemical lumbar sympathectomy with 96% ethanol. The procedure was carried out in the department of vascular surgery. Six days later she was admitted for nausea and vomiting; IVU showed a right-sided retroperitoneal urinoma. The urinoma was drained and the ureter stented. After a month the stent was removed, but hydronephrosis with flank pain followed. The patient then had urosepsis. With a nephrostomy inserted, she was referred for final treatment. From a right flank incision the remnants of obliterated ureteric segment were excised; the retrocaecal appendix was deemed to be a good fit to bridge the gap of 7 cm. To prevent twisting of the mesum, the tip of the appendix had to be anastomosed onto the proximal ureteric end, leaving the base for anastomosis with the distal ureteric end. Both appendiceal ends were spatulated and sutured onto the ureteric ends over a 7 F stent ( Fig. 1) with 4/0 polyglactin. The patient had a 5-day urinary leak through the drain, but then healed. IVU (Fig. 2) and DMSA scintigraphy at 5 and 10 months showed a steadily improving renal function (Fig. 3).
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