Assess the most common clinical presentations of SUI patients, delineate treatment strategies and describe treatment options.Many of these patients will not be offered an AUS or an AUS replacement after erosion or malfunction due to concerns of further complications. Similarly, patient co-morbidities such as recurrent hemorrhagic cystitis requiring repeated continuous bladder irrigations with large-bore catheters not compatible with an AUS or recurrent bladder neck contractures requiring interventions with cystoscopes of standard size may prevent urologists form implanting an AUS. There is also a subset of men in which a second or third AUS implantation, is simply not feasible due to lack of viable urethral tissue, leaving patients incontinent with severe impact on their quality-of-life. Some of these patients will require urinary diversion as last resort.
After this course, attendees should be able:
To assess the most common clinical presentations of these patients, delineate treatment strategies, and describe treatment options
Recognize and identify patients with complex male incontinence and consider the challenges each patient faces and how to effectively and appropriately counsel him.
Identify the challenges AUS placement can pose on patients with certain coexisting conditions such as hemorrhagic cystitis and recurrent bladder neck contracture and how AUS placement remains a feasible option.
Recognize which patients are at increased risk for AUS erosions, how to mitigate these risks preoperatively and identify patients in which AUS placement or replacement remains an option.
Increase awareness for the need of a multidisciplinary approach to these complex and challenging patients as well as to foster multi-institutional collaborative research on this topic for the development of highly needed therapeutic algorithms.
Urinary incontinence is estimated to be prevalent in about 14% of males in the United States. While the exact fraction among these patients suffering from stress urinary incontinence (SUI) is not definitively known, the major etiologies reported for SUI are prostatectomies with incontinence varying between 2% and 43% (depending on definition, surgical technique and length of followup), external beam radiation (1%–16%), and transurethral resection of the prostate (1%–3%). Besides pelvic floor physical therapy, established treatments of SUI are implantation of either male slings or artificial urinary sphincters (AUSs). While the majority of patients can be successfully treated with these options and the choice mainly dependent on degree of SUI, there are instances in which implantation of these devices is not straightforward and further considerations have to be taken into account. Examples of this include multiple prior AUS erosions, recurrent bladder neck contractures, concomitant radiation cystitis with recurrent hematuria, or decreased urethral viability due to prior radiation or urethroplasty. There is limited information about these topics in the literature or textbooks, especially on how to successfully address SUI in these complex settings and, hence, many patients may be left untreated despite viable therapeutic options. As the number of patients treated for prostate cancer has increased in the past 2–3 decades, so will the number of patients who present with complex SUI, making this an emergent and important topic for urologists.