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

Kalra, Sanjay; Pr, Srinivas; Manikandan, Ramanitharan; Dorairajan, Lalgudi Narayanan

doi:10.1136/bcr-2015-209957

Cited by 7 publications

(8 citation statements)

References 2 publications

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“…To control leakage, men resort to absorbent pads, urinary sheaths, body‐worn urinals, and penile compression clamps (PCCs) . 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 . 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 .…”

Section: Introductionmentioning

confidence: 99%

“…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 . 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 .…”

Section: Introductionmentioning

confidence: 99%

“…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 The work was performed at Tel Aviv University and the University of Southampton.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

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%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Even though the congenital cases are more common, one should remember that any urethral injury, infection surgery or even penile clamping could lead to a saccular dilation of the urethra 1 2. A possible mechanism for posterior urethral diverticulum development is after anorectal malformations treatment, with an estimated incidence of 12–18% 3.…”

Section: Discussionmentioning

confidence: 99%

Acquired male urethral diverticulum: a rare entity treated in a one-stage procedure

et al. 2016

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Acquired male urethral diverticulum is a rare entity with most of the literature revolving around case reports or small case series. Up to two-thirds of cases are acquired, mostly as a result of trauma, stricture or infection. Infrequently, some cases develop as a complication of urological procedures, or even penile clamping. We present the case of an adult male with lower urinary tract symptoms, recurrent urinary infections and a history of multiple surgeries to treat a complicated perineal fistulae disease. With the help of imaging techniques, a bulbar urethral diverticulum was discovered. Owing to the symptomatic nature of the diverticulum, an open procedure was performed with excision and primary urethral anastomosis. No urinary symptoms were reported and follow-up imaging and flowmetry demonstrated very good functional outcome.

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Conservative Management of Post-prostatectomy Incontinence

Kennelly

Locke

2017

Post-Prostatectomy Incontinence

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

Cited by 7 publications

References 2 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

Acquired male urethral diverticulum: a rare entity treated in a one-stage procedure

Conservative Management of Post-prostatectomy Incontinence

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