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

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Line 67: Line 67:
# '''Condom'''
# '''Condom'''
# '''Urethral catheter'''
# '''Urethral catheter'''
** '''PFME/PFMT'''
*
*** '''Should be offered to all patients'''
* '''PFME/PFMT'''
*** Advantages:
** '''Should be offered to all patients'''
**** Safe treatment with minimal side-effects
** Advantages:
**** Provides patients with an opportunity to participate in their health outcomes.
*** Safe treatment with minimal side-effects
*** Disadvantages:
*** Provides patients with an opportunity to participate in their health outcomes.
**** Time and effort required
** Disadvantages:
**** Cost of repeated visits for PFMT
*** Time and effort required
** '''Other options that can be used with or without PFME/PFMT:'''
*** Cost of repeated visits for PFMT
*** '''Absorbent pads'''
* '''Other options that can be used with or without PFME/PFMT:'''
*** '''Penile compression devices (clamps)'''
** '''Absorbent pads'''
**** Should not be left on the phallus overnight due to the risks of constant pressure
** '''Penile compression devices (clamps)'''
**** Not suitable for patients with (4):
*** Should not be left on the phallus overnight due to the risks of constant pressure
****# Memory deficits
*** Not suitable for patients with (4):
****# Poor manual dexterity
***# Memory deficits
****# Impaired sensation
***# Poor manual dexterity
****# Significant component of OAB
***# Impaired sensation
*** '''Condom catheters'''
***# Significant component of OAB
*** '''Urethral catheter'''
** '''Condom catheters'''
**** '''Last resort''' in a patient who is unsuitable for alternative management
** '''Urethral catheter'''
**** '''Suprapubic catheter drainage is not a solution for the patient with severe intrinsic sphincter deficiency, as urethral leakage will persist'''
*** '''Last resort''' in a patient who is unsuitable for alternative management
'''Surgical'''
*** '''Suprapubic catheter drainage is not a solution for the patient with severe intrinsic sphincter deficiency, as urethral leakage will persist'''
 
=== Surgical ===
* '''Timing'''
* '''Timing'''
** '''If there is no improvement at 6 months despite conservative therapy and the patient has bothersome IPT,''' (i.e. patient does not want to wait until 12 month time point) '''surgery may be considered for early treatment'''
** '''If there is no improvement at 6 months despite conservative therapy and the patient has bothersome IPT,''' (i.e. patient does not want to wait until 12 month time point) '''surgery may be considered for early treatment'''
Line 98: Line 100:
*#* If there is any doubt as to whether the patient has SUI; all reasonable measures to '''demonstrate SUI on physical exam''', with or without provocative testing such as bending, shifting position, or rising from seated to standing position, should be taken
*#* If there is any doubt as to whether the patient has SUI; all reasonable measures to '''demonstrate SUI on physical exam''', with or without provocative testing such as bending, shifting position, or rising from seated to standing position, should be taken
*# '''Cystourethroscopy should be performed to assess for urethral and bladder pathology that may affect outcomes of surgery'''
*# '''Cystourethroscopy should be performed to assess for urethral and bladder pathology that may affect outcomes of surgery'''
*** '''Patients with symptomatic vesicourethral anastomotic stenosis or bladder neck contracture should be treated prior to surgery for IPT'''
*#* '''Patients with symptomatic vesicourethral anastomotic stenosis or bladder neck contracture should be treated prior to surgery for IPT'''
** '''Urodynamics (UDS) may be performed.'''
*# '''Urodynamics (UDS) may be performed.'''
*** '''UDS are not required before surgical intervention for IPT unless the clinician is in doubt of the diagnosis or it is felt that patient counseling will be affected.'''
*#* '''UDS are not required before surgical intervention for IPT unless the clinician is in doubt of the diagnosis or it is felt that patient counseling will be affected.'''
**** '''During UDS, it is important that the catheter be removed and stress testing repeated in patients with suspected SUI who do not demonstrate stress incontinence with a catheter in place'''
*#** '''During UDS, it is important that the catheter be removed and stress testing repeated in patients with suspected SUI who do not demonstrate stress incontinence with a catheter in place'''
***** Up to 35% of males with post-prostatectomy SUI will not demonstrate SUI with a catheter in place. This may be due to some scarring at the site of the anastomosis. In such cases, even a small catheter can occlude the urethra and prevent stress leakage.
*#*** Up to 35% of males with post-prostatectomy SUI will not demonstrate SUI with a catheter in place. This may be due to some scarring at the site of the anastomosis. In such cases, even a small catheter can occlude the urethra and prevent stress leakage.
* '''Contraindications'''
* '''Contraindications'''
** '''It is not known if poor bladder compliance and an uncorrected storage pressure are absolute contraindications to SUI surgery in IPT patients (***Campbell's lists this as contraindication***). However, these patients should be carefully followed to avoid upper tract decompensation.'''
** '''It is not known if poor bladder compliance and an uncorrected storage pressure are absolute contraindications to SUI surgery in IPT patients (***Campbell's lists this as contraindication***). However, these patients should be carefully followed to avoid upper tract decompensation.'''
Retrieved from "https://urologyschool.com/wikiuro/index.php/AUA:_Incontinence_after_Prostate_Therapy_(2019)"