Editing AUA: Incontinence after Prostate Therapy (2019) (section)

== Special Situations ==

=== Persistent Incontinence after Surgery (AUS or sling) ===

==== Diagnosis and Evaluation ====
* '''Same as prior: history + physical exam +/- other investigations to determine the cause of incontinence'''

==== Causes (4) ====
# '''<span style="color:#ff0000">Inadvertently deactivating the device</span>'''
#* Re-education must be performed
# '''<span style="color:#ff0000">Acute fluid loss</span>'''
#* '''The volume in the pressure regulating balloon can be assessed using computerized tomography or ultrasound.'''
# '''<span style="color:#ff0000">Elevated storage pressures or detrusor over-activity</span>'''
#*'''Should be suspected in a patient with a normally functioning AUS'''
#'''<span style="color:#ff0000">Wear or urethral atrophy</span>'''
#*'''Recurrent incontinence after years of normal function suggests either development of a new leak due to wear or urethral atrophy'''

==== Management ====

*'''For persistent or recurrent SUI after''' 
**'''Sling, an AUS is recommended'''
*** Failure of a male sling can be due to infection or erosion, or more likely, due to patient dissatisfaction with continence recovery
** '''AUS, revision should be considered'''

=== Climacturia ===

* '''In a patient with bothersome climacturia, treatment may be offered.'''

* '''As with post-prostatectomy SUI, for those with sexual arousal incontinence or climacturia, conservative management (emptying the bladder prior to sex, use of condoms to catch the urine, and PFME) should be the initial treatment'''
* '''Imipramine, a tricyclic antidepressant, has been used, but this medication is generally contraindicated in men age > 65 due to the risk of somnolence, falling down, and changes in cognition.'''
* '''Both the AUS and the trans-obturator male sling, when implanted for SUI, are associated with high rates of improvement in climacturia'''

=== Concomitant IPT and erectile dysfunction ===

* '''In patients with concomitant IPT and erectile dysfunction, a concomitant or staged procedure may be offered.'''