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Shaw C, Wagg A. Penile compression devices for the treatment of urinary incontinence: current status and future prospects. Expert Rev Med Devices 2024:1-7. [PMID: 39230092 DOI: 10.1080/17434440.2024.2400092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Urinary incontinence (UI), especially stress UI, is common after prostatectomy. Penile compression devices (PCDs) may be a safe, tolerable option for conservative management in men who are not candidates for or not interested in surgical intervention for their UI. AREAS COVERED This article examines the epidemiology of post-prostatectomy urinary incontinence (PPI), and options for management. All available studies on PCDs are explored, including those on biomechanics, safety, tolerability, and user experience. History, availability of PCDs, and areas for future development are discussed. EXPERT OPINION PCDs are an option for conservative management of PPI. They are recommended for those men without impairment in cognition, dexterity, or sensation. They should be worn for short periods of time and are best used during situations when incontinence might be precipitated. Overall, data suggest they are well tolerated and effective when tested, but large randomized comparative trials and studies of long-term use with relevant patient reported outcome measures are lacking. More studies are needed on commercially available PCDs. Biomechanical studies suggest that there are superior designs and materials both for efficacy and tolerability. With an aging population, and more older men going for prostate surgery, a larger market for these devices is likely.
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Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia in Vancouver, Vancouver, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
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2
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Jula A, Andreasson A, Logadottir Y, Olsen Ekerhult T. Patients experience with the use of a penile clamp in post-prostatectomy incontinence - a prospective pilot study. Scand J Urol 2024; 59:58-62. [PMID: 38462945 DOI: 10.2340/sju.v59.9586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/23/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVES The aim of this study was to assess the efficacy of a penile clamp in managing urinary incontinence (UI) and its impact on perceived quality of life (QoL) amongst post-prostatectomy patients. MATERIAL AND METHODS A prospective pilot study was conducted including patients with post-prostatectomy UI treated with a penile clamp. Inclusion criteria consisted of UI after radical prostatectomy, good hand function, full cognitive function and a minimum penile length of 3 cm and a circumference of 5 cm. An appropriately sized penile clamp was selected during the first visit, and patients were given instructions on how to use it. The first follow-up was a scheduled phone call 1 week after the initial visit. Formal evaluations were performed prior to use of the penile clamp and again after 3 months of usage. These consisted of weighing pads during the daytime with evaluation of leakage, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), incontinence-QoL (I-QoL) and a questionnaire specific for the penile clamp. RESULTS There were 22 patients included, and two were excluded due to reduced hand function and surgery before the study endpoint. The results showed a significant median reduction of urinary leakage of 57% at rest and 58% during physical activity. One complication was observed, as one patient developed a pinching ulcer, after extensive usage. ICIQ-SF showed an increase of 6% for the included patients (n = 20). Ten patients were satisfied with the clamp, and 15 would recommend the clamp to others. CONCLUSION The penile clamp shows promising results in reducing leakage with minimal risks of complications. It can be used as a treatment for patients awaiting surgery. However, patient selection is important regarding hand function, cognitive function and the penile anatomy.
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Affiliation(s)
- Alexandru Jula
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden.
| | - Anders Andreasson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden
| | - Yr Logadottir
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Teresa Olsen Ekerhult
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gotoh D, Torimoto K, Onishi K, Morizawa Y, Hori S, Nakai Y, Miyake M, Fujimoto K. Utility of a penile compression device for the quality of life in male patients with urinary incontinence after prostatectomy (the MORE study): a randomized prospective study. BMC Res Notes 2023; 16:277. [PMID: 37853453 PMCID: PMC10585839 DOI: 10.1186/s13104-023-06564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To verify the effects of penile clamping on the degree of stress urinary incontinence and quality of life in post-radical prostatectomy patients. RESULTS Thirty-seven patients suffering from stress urinary incontinence after undergoing radical prostatectomy were enrolled. A total of 19 and 18 patients were analyzed in the non-clamp and clamp groups, respectively. The mean ages of the patients in non-clamp and clamp groups were 68.3 ± 7.1 years and 71.2 ± 4.8 years, respectively; the mean time after radical prostatectomy was 28.9 ± 44.0 months and 26.2 ± 39.0 months, respectively. The penile clamp used was the CLAMPMED® (URINE CONTROL CLAMP) size M (MURANAKA MEDICAL INSTRUMENTS Co., Ltd.). Specific urinary care pads (Sawayaka Pad for Men, Small Quantity®, Unicharm Corporation), were provided; the average daily usage was monitored for four weeks. The quality of life was evaluated using the King's Health Questionnaire. The average daily use of urinary care pads was significantly reduced in the clamp group than in the non-clamp group (-0.83 ± 1.51 vs. -0.16 ± 0.69, P = 0.0071). King's Health Questionnaire scores did not change significantly in either group. Wearing the CLAMPMED® reduced the amount of urinary incontinence but did not improve the quality of life. TRIAL REGISTRATION The Japan Registry of Clinical Trials (jRCT1052230083). Registered 2 August, 2023.
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Affiliation(s)
- Daisuke Gotoh
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan.
| | - Kenta Onishi
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
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Lee A, Mmonu NA, Thomas H, Rios N, Enriquez A, Breyer BN. Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence. Neurourol Urodyn 2020; 40:384-390. [PMID: 33165983 DOI: 10.1002/nau.24572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
AIMS Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions. METHODS We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns. RESULTS Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps. CONCLUSIONS Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.
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Affiliation(s)
- Austin Lee
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Hannah Thomas
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California, USA
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Lemmens J, Peko Cohen L, Worsley PR, Everitt C, Broadbridge J, Gefen A, Rees RW, Drake M, Macaulay MC, Fader M, Bader DL. Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820920511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases.Methods:Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state.Results:The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp.Conclusions:MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage.Level of evidence:4
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Affiliation(s)
- Joe Lemmens
- School of Health Sciences, University of Southampton, UK
| | - Lea Peko Cohen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | | | | | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | - Marcus Drake
- University of Bristol, Bristol Urological Institute, UK
| | | | - Mandy Fader
- School of Health Sciences, University of Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, UK
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Gresty H, Walters U, Rashid T. Post-prostatectomy incontinence: multimodal modern-day management. Br J Community Nurs 2019; 24:154-159. [PMID: 30969852 DOI: 10.12968/bjcn.2019.24.4.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As the rate of prostate cancer detection increases, so does the rate at which radical prostatectomy is performed. Post-prostatectomy incontinence (PPI) or urine leakage affects around 20% of men who undergo this procedure. Although affected individuals must be supported in maintaining hygiene with the use of urine capture devices, definitive treatment should also be offered if appropriate. A range of management options are available, from incontinence pads to artificial urinary sphincters. However, an understanding of the aetiology of the leak as well as patient factors is vital if the correct treatment option is to be selected. This article describes the potential causes of PPI and explores management options for this condition.
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Affiliation(s)
- Helena Gresty
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
| | - Uma Walters
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
| | - Tina Rashid
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
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Sharaf A, Fader M, Macaulay M, Drake MJ. Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence. Low Urin Tract Symptoms 2018; 11:133-138. [PMID: 30561138 DOI: 10.1111/luts.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In severe post-prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson-Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H2 O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post-prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H2 O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.
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Affiliation(s)
- Ala'a Sharaf
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Mandy Fader
- School of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Scientific and Clinical Abstracts From the WOCN® Society's 50th Annual Conference. J Wound Ostomy Continence Nurs 2018. [DOI: 10.1097/won.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Levy A, Fader M, Bader D, Gefen A. Penile compression clamps: A model of the internal mechanical state of penile soft tissues. Neurourol Urodyn 2016; 36:1645-1650. [DOI: 10.1002/nau.23172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/13/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ayelet Levy
- Department of Biomedical Engineering; Tel Aviv University; Tel Aviv Israel
| | - Mandy Fader
- Faculty of Health Sciences; University of Southampton; Southampton United Kingdom
| | - Daniel Bader
- Faculty of Health Sciences; University of Southampton; Southampton United Kingdom
| | - Amit Gefen
- Department of Biomedical Engineering; Tel Aviv University; Tel Aviv Israel
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Kalra S, Srinivas PR, Manikandan R, Dorairajan LN. Urethral diverticulum: a potential hazard of penile clamp application for male urinary incontinence. BMJ Case Rep 2015; 2015:bcr-2015-209957. [PMID: 25858949 DOI: 10.1136/bcr-2015-209957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sidhartha Kalra
- Department of Urology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
| | - P Rao Srinivas
- Department of Urology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
| | - Ramanitharan Manikandan
- Department of Urology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
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Macaulay M, Broadbridge J, Gage H, Williams P, Birch B, Moore KN, Cottenden A, Fader MJ. A trial of devices for urinary incontinence after treatment for prostate cancer. BJU Int 2015; 116:432-42. [PMID: 25496354 DOI: 10.1111/bju.13016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. PATIENTS AND METHODS Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. RESULTS Substantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. CONCLUSIONS This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.
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Affiliation(s)
- Margaret Macaulay
- Continence and Skin Technology Group, University College London, London, UK
| | - Jackie Broadbridge
- Department of Economics, University of Surrey, Guildford, UK.,Continence and Skin Technology Group, University of Southampton, Southampton, UK
| | - Heather Gage
- Department of Economics, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
| | - Brian Birch
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Alan Cottenden
- Continence and Skin Technology Group, University College London, London, UK
| | - Mandy J Fader
- Continence and Skin Technology Group, University of Southampton, Southampton, UK
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