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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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Ng ATL, Lam W. The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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MacKenzie KR, Davis J, Harding C, Aning JJ. Patient-reported outcomes and urodynamic findings in men with persistent lower urinary tract symptoms following robot-assisted radical prostatectomy. Neurourol Urodyn 2019; 38:1353-1362. [PMID: 30980415 DOI: 10.1002/nau.23986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/01/2019] [Accepted: 03/07/2019] [Indexed: 11/06/2022]
Abstract
AIMS To evaluate the patient-reported outcome measures (PROMs) and urodynamic findings in men seeking intervention for lower urinary tract symptoms (LUTS) after robotic-assisted radical prostatectomy (RARP) in a regional referral center for continence surgery. METHODS Consecutive men with post-RARP LUTS, who were referred for specialist evaluation and urodynamics between December 2012 and October 2017, were evaluated. Men were invited to complete the International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form (ICIQ-MLUTS) pre-operatively and at 6, 12 and 18 months post-RARP. RESULTS In total 64/860 (7.4%) men post-RARP were referred for specialist evaluation. There was a significant increase in total ICIQ-MLUTS and bother scores at 6, 12 and 18 months compared with the baseline in these men (P < 0.001 and P < 0.05, respectively). Urodynamics identified 41/64 (64%) had urodynamic stress incontinence (USI) only, 2/64 (3%) had detrusor overactivity (DO) only and 11/64 (17%) had a combination of USI and DO. Of those referred to a continence specialist 29/64 (45%) underwent a continence procedure. CONCLUSIONS Patients with bothersome LUTS post-RARP have higher baseline ICIQ-MLUTs scores and significant worsening of total scores at all time points compared with the baseline. Routine use of PROMs may identify patients at risk of bothersome symptoms after RARP and prompt earlier referral for further management of their LUTS. Urodynamic evaluation revealed that the most common finding was pure stress incontinence but the range of urodynamic diagnoses highlights the need to perform urodynamics before making treatment decisions for men with LUTS post-RARP.
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Affiliation(s)
- Kenneth R MacKenzie
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James Davis
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jonathan J Aning
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Tran MG, Sut MK, Collie J, Neves JB, Al-Hayek S, Armitage JN, Couturier DL, Wiseman OJ. Development of a Disease-Specific Ureteral Calculus Patient Reported Outcome Measurement Instrument. J Endourol 2018; 32:548-558. [DOI: 10.1089/end.2017.0795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maxine G.B. Tran
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, United Kingdom
- Specialist Center for Kidney Cancer, Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Michal K. Sut
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
- Department of Urology, Peterborough City Hospital, Peterborough, United Kingdom
| | - Jane Collie
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | - Joana B. Neves
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, United Kingdom
- Specialist Center for Kidney Cancer, Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Samih Al-Hayek
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | - James N. Armitage
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | | | - Oliver J. Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
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5
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The assessment and management of post-prostatectomy stress urinary incontinence. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bretterbauer KM, Huber ER, Remzi M, Huebner W. Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations. Int Braz J Urol 2016; 42:986-992. [PMID: 27532111 PMCID: PMC5066896 DOI: 10.1590/s1677-5538.ibju.2015.0194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 01/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. Materials and Methods: Between 2000 and 2008 a retrospective chart review and telephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telephone survey) was 34.8 ± 22.8 months (median 32). Results: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were “very satisfied” and “satisfied”. In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. Conclusions: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior incontinence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated superior satisfaction rates.
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Affiliation(s)
| | | | - Mesut Remzi
- Landesklinikum Korneuburg - Urology Korneuburg, Austria
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Rehder P, Staudacher NM, Schachtner J, Berger ME, Schillfahrt F, Hauser V, Mueller R, Skradski V, Horninger W, Glodny B. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence. Adv Urol 2016; 2016:6054730. [PMID: 27022393 PMCID: PMC4752977 DOI: 10.1155/2016/6054730] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/05/2016] [Indexed: 11/18/2022] Open
Abstract
The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the "cushion" of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA).
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Affiliation(s)
- Peter Rehder
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Nina M. Staudacher
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Joerg Schachtner
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Maria E. Berger
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Florian Schillfahrt
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Verena Hauser
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Raphael Mueller
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Viktor Skradski
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
| | - Bernhard Glodny
- Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria
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Selph JP, Belsante MJ, Gupta S, Ajay D, Lentz A, Webster G, Le NBP, Peterson AC. The Ohmmeter Identifies the Site of Fluid Leakage during Artificial Urinary Sphincter Revision Surgery. J Urol 2015; 194:1043-8. [DOI: 10.1016/j.juro.2015.05.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- John Patrick Selph
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Michael James Belsante
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Shubham Gupta
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Divya Ajay
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Aaron Lentz
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - George Webster
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Ngoc-Bich P. Le
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
| | - Andrew C. Peterson
- Divisions of Urology and Reconstructive Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University of Kentucky (SG), Lexington, Kentucky
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