Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence — Is It the Best Option?

Abstract

Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.

Standing cough test stratification of moderate male stress urinary incontinence

“…Current guidelines state that men with moderate SUI are candidates for either an AUS or a transobturator sling, but there are no established protocols for further stratifying these patients (6,12,13,19). In this study, we found that almost 40% of men who reported moderate SUI demonstrated severe leakage on SCT, suggesting that subjective assessment of SUI is inadequate to fully characterize SUI severity.…”

“…Prior studies have demonstrated that pre--operative 24-hour pad weight, PPD usage, and MSIGS scores are all predictors of sling success (5,(16)(17)(18)(19)(20)(21). PPD usage is a simple way to estimate SUI severity.…”

Pelvic floor muscle exercise and training for coping with urinary incontinence

“…Do 5 exercises holding for 5-10 sec. Do 2 exercise sessions each day, one in the morning and one in the evening, for a total of 60 exercises prostatectomy (Ha and Yoo, 2019). Trials of PFME for post-prostatectomy urinary incontinence show that PFME reduces urinary incontinence in the first 3 months after surgery (Campbell et al, 2012).…”

Treatment of Stress Urinary Incontinence with Muscle Stem Cells and Stem Cell Components: Chances, Challenges and Future Prospects

“…Additionally, the use of selective serotonin noradrenaline inhibitors (SSNRI), estrogens and desmopressin may be supportive. The available surgical options are manifold: paraurethral injection therapy (“bulking agents”), tension free vaginal tapes (TVTs), pubovaginal or mid-urethral urethral slings (retropubic vs. transobturatorial vs. autologous fascia), Burch colposuspension (open or laparoscopic) and artificial urinary sphincter and compression systems [ 11 , 40 , 41 , 42 , 43 ]. These interventions render a significant amelioration of the clinical symptoms and enable the recovery of continence with around 80% cure rates [ 44 ].…”