In the last decade, we made great strides in the management of post-prostatectomy urinary incontinence (PPI), but the quest for the “perfect” device continues (Doherty and Almallah. BMJ 343:d6298, 2011). This chapter aims to familiarize the practicing urologist with new horizons in treatment of PPI.
Placement of an artificial urinary sphincter (AUS) has typically been recognized as the most reliable treatment for men with severe PPI. Various slings are available and have been discussed in the previous chapters, but none have shown success rates equal to that of the AUS for the treatment of severe stress incontinence. Bulking agents have shown poor efficacy and durability. Attempts have been made to engineer other mechanical devices to improve PPI, but none have gained widespread acceptance, and none are approved in the United States. Others suggest that rather than mechanical devices, tissue-based solutions will be the next treatment for PPI. Studies utilizing stem cells show promise in both animal and human models, but thus far no large studies have shown durability or efficacy.
Furthermore, as a group of urologists with special passion to help patients with PPI, we should also step back and look at the bigger picture. Emphasis should be directed toward prevention of PPI, optimizing prostate cancer management, surgical training, and techniques (including the exploration of controversial focal therapy) to reduce the burden and complications of prostate cancer therapy. Additionally, patients’ education, identification, and design of referral pathways to a specialized male incontinence clinics and prostate cancer survivor programs may represent the future model of care (Almallah and Grimsley SJ. Ther Adv Urol 7(2):69–75, 2015).
Post-prostatectomy Urinary incontinence New technology
American Medical Systems
Adjustable transobturator male system
Artificial urinary sphincter
Tape mechanical occlusive device
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