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AUA: Incontinence after Prostate Therapy (2019): Difference between revisions

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==== Timing ====
==== Timing ====
* '''<span style="color:#ff0000">If there is no improvement at 6 months despite conservative therapy and the patient has bothersome IPT,</span>''' (i.e. patient does not want to wait until 12 month time point) '''surgery may be considered for early treatment'''
* '''<span style="color:#ff0000">If there is no improvement at 6 months despite conservative therapy and the patient has bothersome IPT,</span>''' (i.e. patient does not want to wait until 12 month time point) '''<span style="color:#ff0000">surgery may be considered for early treatment'''
** While almost all patients have reached their maximum improvement by 12 months, most patients with severe SUI will show no significant improvement after 6 months and may be candidates for early intervention
** While almost all patients have reached their maximum improvement by 12 months, most patients with severe SUI will show no significant improvement after 6 months and may be candidates for early intervention
* '''<span style="color:#ff0000">Otherwise, treatment should be offered to patients with persistent bothersome SUI at 12 months.</span>'''
* '''<span style="color:#ff0000">Otherwise, treatment should be offered to patients with persistent bothersome SUI at 12 months.</span>'''
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** '''<span style="color:#ff0000">If identified during implantation, procedure should be abandoned and subsequent implantation should be delayed</span>'''
** '''<span style="color:#ff0000">If identified during implantation, procedure should be abandoned and subsequent implantation should be delayed</span>'''
* '''<span style="color:#ff0000">Persistent leakage</span>'''
* '''<span style="color:#ff0000">Persistent leakage</span>'''
* '''<span style="color:#ff0000">Mechanical failure</span>'''
* '''<span style="color:#ff0000">Cuff erosion</span>'''
* '''<span style="color:#ff0000">Cuff erosion</span>'''
** Can be due to unrecognized urethral injury at the time of initial surgery or more likely due to subsequent instrumentation of the urethra including catheterization.
** Can be due to unrecognized urethral injury at the time of initial surgery or more likely due to subsequent instrumentation of the urethra including catheterization.
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*** '''AUS should not be re-implanted until at least 3 months'''
*** '''AUS should not be re-implanted until at least 3 months'''
* '''<span style="color:#ff0000">Infection</span>'''
* '''<span style="color:#ff0000">Infection</span>'''
** '''Device infection occurs in <1-5% of cases'''
** '''<span style="color:#ff0000">Device infection occurs in <1-5% of cases'''
** '''Presents with pain at the site of the AUS, fever, scrotal warmth or erythema, or skin changes'''
** '''<span style="color:#ff0000">Diagnosis and Evaluation'''
** '''Management:'''
***'''<span style="color:#ff0000">History and Physical Exam'''
*** '''Urgent AUS explantation'''
****'''<span style="color:#ff0000">Presents with (4):'''
****#'''<span style="color:#ff0000">Pain at the site of the AUS'''
****#'''<span style="color:#ff0000">Fever'''
****#'''<span style="color:#ff0000">Scrotal warmth or erythema'''
****#'''<span style="color:#ff0000">Skin changes'''
** '''<span style="color:#ff0000">Management:'''
*** '''<span style="color:#ff0000">Urgent AUS explantation'''
*** '''AUS should not be reimplanted until at least 3 months''' to allow the infection to clear and inflammation to subside.
*** '''AUS should not be reimplanted until at least 3 months''' to allow the infection to clear and inflammation to subside.
* '''<span style="color:#ff0000">Decreased efficacy over time and reoperations are common</span>'''
* '''<span style="color:#ff0000">Mechanical failure</span>'''
*'''<span style="color:#ff0000">Decreased efficacy over time and reoperations are common</span>'''
** '''The current version consists of''' a hydraulic system composed of '''3 separate parts:'''
** '''The current version consists of''' a hydraulic system composed of '''3 separate parts:'''
**# '''A urethral cuff''' of varying sizes
**# '''A urethral cuff''' of varying sizes
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*** '''≈24% at 5 years'''
*** '''≈24% at 5 years'''
*** '''≈ 50% at 10 years'''
*** '''≈ 50% at 10 years'''
** '''An AUS might need to be replaced over time due to persistent or recurrent incontinence generally due to:'''
** '''AUS might need to be replaced over time due to persistent or recurrent incontinence generally due to (3):'''
**# '''Urethral atrophy'''
**# '''Urethral atrophy'''
**# '''Improper cuff sizing'''
**# '''Improper cuff sizing'''
**# '''Partial fluid loss'''
**# '''Partial fluid loss'''
===== Urinary diversion =====
===== Urinary diversion =====
* '''Can be considered in appropriately motivated and counseled patients who are unable to obtain adequate long-term quality of life'''
* '''Can be considered in appropriately motivated and counseled patients who are unable to obtain adequate long-term quality of life'''
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