The penile clamp: Medieval pain or makeshift gain?

Barnard, Jon; Westenberg, Andre M.

doi:10.1002/nau.22597

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…However, PCCs do not completely eliminate urine leakage when applied at a comfortable pressure and pain is reported when compression is sufficient to prevent leakage . Case reports describe reduced penile blood flow and deformation‐inflicted tissue damage, but there is no evaluative data assessing the effect of various penile clamp designs and the real life potential for injury . The purpose of this study was to develop a computational model of the internal mechanical state of the penis when compressed by a range of PCC designs.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Case reports describe reduced penile blood flow and deformation-inflicted tissue damage, but there is no evaluative data assessing the effect of various penile clamp designs and the real life potential for injury. 8,9 The purpose of this study was to develop a computational model of the internal mechanical state of the penis when compressed by a range of PCC designs. This study is part of a larger programme of work to design an effective, comfortable, and low risk PCC.…”

Section: Introductionmentioning

confidence: 99%

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Penile compression clamps: A model of the internal mechanical state of penile soft tissues

Levy

Fader

Bader

et al. 2016

Neurourology and Urodynamics

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Aims: Prostate cancer is the most frequently diagnosed cancer, and male incontinence represents a major consequence following surgery. Penile compression clamps (PCCs) which externally occlude the urethra, may be used to manage the incontinence. Despite potential complication of PCCs, such as deformation-inflicted tissue damage, to date, there are no reported biomechanical criteria for design of PCCs, in terms of quantitative parameters for evaluating the safety-versus-efficacy of existing or future designs.Methods: we developed a set of computational three-dimensional models of the penis, to which compression was applied using five generic PCC designs. The internal mechanic states of the soft tissues of the penis were then analysed using finite element simulations.Results: Stresses in skin, fat and tunica albuginea regularly exceeded 10 kPa (75mmHg). Cuff-type and knurl-type PCCs pose the highest potential risks to tissue health with elevated tissue stresses around the entire penile perimeter (cuff) or urethral stress concentrations (knurl). The soft and contoured PCCs produced the lowest values of these mechanical parameters. Conclusion:The present study identified design characteristics, being envelopment, adaptability and durability, which provide the safest mechanical conditions in the penis and thus minimize the risk of tissue damage while still managing incontinence. Such data should help to design a safer clamp. Frequent off-loading of the penile tissues should be emphasized to patients, to prevent deformation-inflicted tissue damage. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 To control leakage, men resort to absorbent pads, urinary sheaths, body-worn urinals and penile compression clamps (PCCs). 4,5 Designed to externally occlude the urethra, PCCs have been reported to reduce the impact of incontinence and be particularly useful for managing incontinence during activities. 6,7 However, PCCs do not completely eliminate urine leakage when applied at a comfortable pressure and pain is reported when compression is sufficient to prevent leakage. 5,6 Case reports describe reduced penile blood flow and deformation-inflicted tissue damage, but there is no evaluative data assessing the effect of various penile clamp designs and the real life potential for injury. 8,9 The purpose of this study was to develop a computational model of the internal mechanical state of the penis when compressed by a range of PCC designs. This study is part of a larger programme of work to design an effective, comfortable and low risk PCC. Materials & Methods GeometryTwelve FE model variants (models) were developed, representing five generic designs and three stiffnesses of interface materials representative of PCCs currently available on the internet (see Table 1). Each model was based on an anatomical description of the 3D structure of ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Penile compression clamps: A model of the internal mechanical state of penile soft tissues

Levy

Fader

Bader

et al. 2016

Neurourology and Urodynamics

View full text Add to dashboard Cite

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“…This is the first clinical trial comparing performance of three male‐specific devices for continence management and absorbent pads, and the first to examine user preferences immediately after testing and actual use (revealed preferences) several months later. It is also the first published trial of BWUs (there have been clinical trials of urinary sheaths , absorbent pads , and penile clamps , and) thus provides valuable clinical information on the differences between products, their strengths and limitations, and the need for individual support in choice of products for different activities.…”

Section: Discussionmentioning

confidence: 99%

A trial of devices for urinary incontinence after treatment for prostate cancer

et al. 2015

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ObjectiveTo compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. Patients and MethodsRandomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. ResultsSubstantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. ConclusionsThis is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design. Keywordspenile compression device, body-worn urinal, sheath drainage system, King's Health Questionnaire, quality of life IntroductionProstate cancer is the commonest male cancer in the UK [1]. About 10-15% of men who undergo surgical or non-surgical treatment for prostate cancer will be left with lifelong urinary incontinence (UI) [2][3][4]. UI has major negative effects on quality of life (QoL) and social interactions [5][6][7][8][9][10][11], and is associated with long-term morbidities such as skin injury, UTI, falls, and increased hospital stays [12]. For those who do not regain continence, absorbent pads or alternative products and devices are required to maintain social continence.In addition to the usual choice of absorbent pads, other continence products include penile compression devices (clamp), sheath/condom drainage systems (sheath), and bodyworn urinals (BWU). In the UK the latter two are available on NHS prescription. However, their market share is low compared with the use of absorbent pro...

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“…However, in patients who are not fit to undergo another surgery or cannot afford these devices, especially in developing countries, penile compression devices come in handy. Use of these devices has been shown to cause a significant reduction in Incontinence Impact Questionnaire scores in different studies 1. However, these devices have the risk of complications such as pain, urethral erosion, obstruction and oedema, with long-term use.…”

Section: Descriptionmentioning

confidence: 99%

The penile clamp: Medieval pain or makeshift gain?

Abstract: This study demonstrates that men who used the penile compression device reduced their Incontinence Impact Questionnaire scores significantly. Further research into the side effect profile of the device is needed as its utility may be under appreciated.

Cited by 14 publications

References 8 publications

Penile compression clamps: A model of the internal mechanical state of penile soft tissues

Penile compression clamps: A model of the internal mechanical state of penile soft tissues

A trial of devices for urinary incontinence after treatment for prostate cancer

Urethral diverticulum: a potential hazard of penile clamp application for male urinary incontinence

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