Functional: Surgery for Male SUI: Difference between revisions

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== Management ==

* '''Patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence should be offered treatment options per the [[AUA: Overactive Bladder (2019)|AUA Overactive Bladder Guidelines]]'''

=== Options ===

* '''~~Conservative~~:'''

* '''Non-surgical (6):'''

** '''Pelvic floor muscle training'''

*#'''Pelvic floor muscle exercises (PFME)/Pelvic floor muscle training (PFMT)'''

* '''~~Non-surgical~~:'''

*#'''Absorbent pads'''

** '''~~Pharmacological~~'''

*#'''Penile compression devices''' such as Dribble-Stop

*** Duloxetine, a serotonin norepinephrine reuptake inhibitor, can be tried

*#'''Condom catheter'''

** '''~~Penile clamp~~''' ~~such as Dribble-Stop~~

*# '''Urethral catheter'''

** '''~~Containment products~~''' ~~such as a condom catheter, urethral, or suprapubic catheter or incontinence pads.~~

*#'''Duloxetine (a serotonin norepinephrine reuptake inhibitor)'''

*#*All except duloxetine are described in 2019 AUA Guidelines on Incontinence After Prostate Therapy

* '''Surgical'''

* '''Surgical (5):'''

*# '''Transurethral bulking agent'''

*# '''Adjustable balloon devices (ProACT)'''

*# '''Bulbar urethral sling'''

*# '''ProACT balloon'''

*# '''Artificial Urinary Sphincter (AUS)'''

*# '''Bladder neck closure with diversion'''

=== ~~Conservative~~ ===

=== Non-surgical ===

==== '''Pelvic floor muscle exercises (PFME)/Pelvic floor muscle training (PFMT)''' ====

*'''Should be offered to all patients[https://pubmed.ncbi.nlm.nih.gov/31059663/ ★]'''

*Advantages:

**Safe treatment with minimal side-effects

**Provides patients with an opportunity to participate in their health outcomes.

*Disadvantages:

**Time and effort required

**Cost of repeated visits for PFMT

* '''Males with SUI should initially be treated with''' '''pelvic floor muscle training for at least 3 months'''

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** Progressive improvement in urinary control has been reported to occur for as long as 2 years after surgery

==== Penile Compression Devices ====*Should not be left on the phallus overnight due to the risks of constant pressure

*'''Not suitable for patients with (4):[https://pubmed.ncbi.nlm.nih.gov/31059663/ ★]'''

*#'''Memory deficits'''

*#'''Poor manual dexterity'''

*#'''Impaired sensation'''

*#'''Significant component of OAB'''

==== Urethral catheter ====

*'''Last resort''' in a patient who is unsuitable for alternative management

*'''Suprapubic catheter drainage is not a solution for the patient with severe intrinsic sphincter deficiency, as urethral leakage will persist'''

=== Surgical ===

@@ Line 77: / Line 77: @@
 == Management ==
+* '''<span style="color:#ff0000">Patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence should be offered treatment options per the [[AUA: Overactive Bladder (2019)|AUA Overactive Bladder Guidelines]]</span>'''
 === Options ===
-* '''Conservative:'''
+* '''Non-surgical (6):'''
-** '''Pelvic floor muscle training'''
+*#'''<span style="color:#ff0000">Pelvic floor muscle exercises (PFME)/Pelvic floor muscle training (PFMT)</span>'''
-* '''Non-surgical:'''
+*#'''<span style="color:#ff0000">Absorbent pads</span>'''
-** '''Pharmacological'''
+*#'''<span style="color:#ff0000">Penile compression devices</span>''' such as Dribble-Stop
-*** Duloxetine, a serotonin norepinephrine reuptake inhibitor, can be tried
+*#'''<span style="color:#ff0000">Condom catheter</span>'''
-** '''Penile clamp''' such as Dribble-Stop
+*# '''<span style="color:#ff0000">Urethral catheter</span>'''
-** '''Containment products''' such as a condom catheter, urethral, or suprapubic catheter or incontinence pads.
+*#'''Duloxetine (a serotonin norepinephrine reuptake inhibitor)'''
+*#*All except duloxetine are described in 2019 AUA Guidelines on Incontinence After Prostate Therapy
-* '''Surgical'''
+* '''Surgical (5):'''
 *# '''Transurethral bulking agent'''
+*# '''Adjustable balloon devices (ProACT)'''
 *# '''Bulbar urethral sling'''
-*# '''ProACT balloon'''
 *# '''Artificial Urinary Sphincter (AUS)'''
 *# '''Bladder neck closure with diversion'''
-=== Conservative ===
+=== Non-surgical ===
+==== <span style="color:#ff0000">'''Pelvic floor muscle exercises (PFME)/Pelvic floor muscle training (PFMT)'''</span> ====
+*'''<span style="color:#ff0000">Should be offered to all patients[https://pubmed.ncbi.nlm.nih.gov/31059663/ ★]</span>'''
+*Advantages:
+**Safe treatment with minimal side-effects
+**Provides patients with an opportunity to participate in their health outcomes.
+*Disadvantages:
+**Time and effort required
+**Cost of repeated visits for PFMT
 * '''Males with SUI should initially be treated with''' '''pelvic floor muscle training for at least 3 months'''
@@ Line 101: / Line 113: @@
 ** Progressive improvement in urinary control has been reported to occur for as long as 2 years after surgery
+==== Penile Compression Devices ====*Should not be left on the phallus overnight due to the risks of constant pressure
+*<span style="color:#ff0000">'''Not suitable for patients with (4):[https://pubmed.ncbi.nlm.nih.gov/31059663/ ★]'''</span>
+*#<span style="color:#ff0000">'''Memory deficits'''</span>
+*#<span style="color:#ff0000">'''Poor manual dexterity'''</span>
+*#<span style="color:#ff0000">'''Impaired sensation'''</span>
+*#<span style="color:#ff0000">'''Significant component of OAB'''</span>
+==== Urethral catheter ====
+*'''<span style="color:#ff0000">Last resort</span>''' in a patient who is unsuitable for alternative management
+*'''Suprapubic catheter drainage is not a solution for the patient with severe intrinsic sphincter deficiency, as urethral leakage will persist'''
 === Surgical ===