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Surgery Insight: surgical management of postprostatectomy incontinence--the artificial urinary sphincter and male sling.
Nat Clin Pract Urol. 2007 Nov; 4(11):615-24.NC

Abstract

Stress urinary incontinence in men is usually a result of intrinsic sphincter deficiency following prostate cancer surgery. Active conservative management with fluid restriction, medication management and pelvic floor exercises is indicated for the first 12 months. If bothersome incontinence persists, urodynamic evaluation is indicated in order to assess detrusor storage function, contractility and sphincteric integrity. Standard surgical options include urethral bulking agents, artificial urinary sphincter (AUS) and male sling. Periurethral injection of bulking agents is satisfactory in only a minority of patients, leaving AUS and male sling as the most common surgical treatments. In patients with severe urinary incontinence, AUS seems to have a higher rate of success than the male sling. Furthermore, AUS is indicated in men with detrusor hypocontractility as adequate detrusor contractility is needed to overcome the fixed resistance of the sling. In patients with milder levels of stress incontinence, the two techniques have approximately equal efficacy in the short-to-intermediate term. While current reports of the male sling are generally limited to 1-4 years' follow-up, the infection, erosion, and revision rate for the male sling seem somewhat lower than that for the AUS in appropriately chosen patients.

Authors+Show Affiliations

Department of Urology, Stanford University, Stanford, CA 94305-5118, USA. urology@med.stanford.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17982438

Citation

Comiter, Craig V.. "Surgery Insight: Surgical Management of Postprostatectomy Incontinence--the Artificial Urinary Sphincter and Male Sling." Nature Clinical Practice. Urology, vol. 4, no. 11, 2007, pp. 615-24.
Comiter CV. Surgery Insight: surgical management of postprostatectomy incontinence--the artificial urinary sphincter and male sling. Nat Clin Pract Urol. 2007;4(11):615-24.
Comiter, C. V. (2007). Surgery Insight: surgical management of postprostatectomy incontinence--the artificial urinary sphincter and male sling. Nature Clinical Practice. Urology, 4(11), 615-24.
Comiter CV. Surgery Insight: Surgical Management of Postprostatectomy Incontinence--the Artificial Urinary Sphincter and Male Sling. Nat Clin Pract Urol. 2007;4(11):615-24. PubMed PMID: 17982438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery Insight: surgical management of postprostatectomy incontinence--the artificial urinary sphincter and male sling. A1 - Comiter,Craig V, PY - 2007/05/31/received PY - 2007/08/21/accepted PY - 2007/11/6/pubmed PY - 2007/12/14/medline PY - 2007/11/6/entrez SP - 615 EP - 24 JF - Nature clinical practice. Urology JO - Nat Clin Pract Urol VL - 4 IS - 11 N2 - Stress urinary incontinence in men is usually a result of intrinsic sphincter deficiency following prostate cancer surgery. Active conservative management with fluid restriction, medication management and pelvic floor exercises is indicated for the first 12 months. If bothersome incontinence persists, urodynamic evaluation is indicated in order to assess detrusor storage function, contractility and sphincteric integrity. Standard surgical options include urethral bulking agents, artificial urinary sphincter (AUS) and male sling. Periurethral injection of bulking agents is satisfactory in only a minority of patients, leaving AUS and male sling as the most common surgical treatments. In patients with severe urinary incontinence, AUS seems to have a higher rate of success than the male sling. Furthermore, AUS is indicated in men with detrusor hypocontractility as adequate detrusor contractility is needed to overcome the fixed resistance of the sling. In patients with milder levels of stress incontinence, the two techniques have approximately equal efficacy in the short-to-intermediate term. While current reports of the male sling are generally limited to 1-4 years' follow-up, the infection, erosion, and revision rate for the male sling seem somewhat lower than that for the AUS in appropriately chosen patients. SN - 1743-4289 UR - https://www.unboundmedicine.com/medline/citation/17982438/Surgery_Insight:_surgical_management_of_postprostatectomy_incontinence__the_artificial_urinary_sphincter_and_male_sling_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=17982438.ui DB - PRIME DP - Unbound Medicine ER -