The treatment of stress incontinence in men: part 2 of a series of articles on incontinence

A Novel Concept for Unidirectional Communication With an Active Implant Based on Deliberately Produced Human Body Signals

A new patient-friendly and discrete approach to build a unidirectional communication path with active implants based on deliberately produced human body signals is presented. The application for which this approach is intended is an artificial urinary sphincter implant, the closure mechanism of which is wirelessly actuated in the event of micturition need. Conventional implant communication methods can be associated with limitations regarding technological implementation and usability, and are used by medical professionals only. In order to enable patients to discretely and directly communicate with their implant without the need for an external handheld device, the feasibility of a communication approach based on manually applied 'knocking' signals on abdominal tissue is examined in the presented work. A gelatin-based phantom model is used to mimic vibro-acoustic properties of human soft tissue in vitro. A piezoelectric element and an electret microphone are applied as sensors for signal detection at the implantation site and are investigated with respect to their suitability for the intended application. Clinical Relevance- The presented implant communication method can contribute to urinary incontinence therapy by enabling patients to discretely and user-friendly actuate their artificial sphincter implant and can provide a basis for future research into new implant communication technologies.

Use of EPIC 26 to identify men likely to benefit from surgical interventions for urinary incontinence after radical prostatectomy

PURPOSE

To examine outcomes of surgical procedures for urinary incontinence after radical prostatectomy (post-RP UI) and to identify patients who may benefit from a surgical intervention to treat post-RP UI.

METHODS

A retrospective chart review identified men who underwent radical prostatectomy (RP) from July 2004 through July 2016 at our institution. Cases underwent surgical interventions for UI following RP. Controls had RP during the study period but did not have an intervention for UI following RP. We used the UI scale of the Expanded Prostate Index Composite (EPIC) 26 to: (1) quantify post-RP UI before and after UI intervention overall and for specific surgical procedures; (2) evaluate the significance of improvement in post-RP UI before and after UI intervention and (3) identify controls with levels of post-RP UI that were comparable to the cases.

RESULTS

Two thousand nine hundred and sixty-eight RPs were performed; 48 patients underwent further surgical intervention (39 slings, 9 artificial urinary sphincter, AUS). For 20 cases with complete EPIC UI data (15 slings, 5 AUS), the median (IQR) pre-UI intervention score was 27.00 (IQR 22.75-42.75). Improvement was significant overall (p < 0.001) and for slings (p = 0.001). 71/2085 controls had post-prostatectomy UI scores ≤ 27.0, suggesting that they may have benefited from a post-RP surgical intervention for UI.

CONCLUSION

Data support the effectiveness of surgery to treat post-RP UI. A sizeable population of unidentified men may benefit from a surgical intervention to treat urinary incontinence after RP.

[Prostate artery embolization (PAE) : Technique and results]

CLINICAL/METHODICAL ISSUE

In the treatment of the benign prostatic hyperplasia (BPH) medical and surgical therapies have been established.

STANDARD RADIOLOGICAL METHODS

Prostate artery embolization (PAE) is an innovative endovascular technique that might close the gap between both these procedures.

PERFORMANCE

The PAE procedure is safe and has a low incidence of side effects. The efficacy of PAE has been proven for medium sized and large sized glands as well as for intravesical protrusions.

ACHIEVEMENTS

The complex mechanism of PAE carries the potential to cure lower urinary tract symptoms as well as to retard the progression of the hyperplasia.

PRACTICAL RECOMMENDATIONS

Data concerning the long-term efficacy are missing at present.

Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery

The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results.

Coadministration of low-dose serotonin/noradrenaline reuptake inhibitor (SNRI) duloxetine with α 2-adrenoceptor blockers to treat both female and male mild-to-moderate stress urinary incontinence (SUI)

BACKGROUND

Female urinary incontinence is a relatively common disorder affecting women in different age groups, with significant prevalence amounts of stress-related subtype (stress urinary incontinence, SUI). Various neurotransmitters/neuromodulators - particularly both the glutamatergic and GABA-ergic ones - are involved in micturition/urinary continence nerve centre-based control, where Onuf's nucleus plays an important functional role under the adiuvant serotoninergic/ noradrenergic influences.

OBJECTIVES

To outline, deriving them from the literature review, the SUI therapeutic implications of SNRI (serotonin-noradrenaline reuptake inhibitors) particularly of the duloxetine, though displaying its full therapeutic dose (40 mg twice/day)-related side effects and, therefore, highlighting recent issues concerning novel drug administration modalities to avoid such adverse events. EMERGING KNOWLEDGES: Intriguing studies in SUI animal models have shown that co-administration of duloxetine low dose with α 2-adrenoceptor antagonists - given the α 2-adrenoceptor inhibition-induced enhancement of duloxetine effectiveness on the urethral rhabdospincter-can avoid the duloxetine-related adverse events though perspectively reaching, in perspective translational clinical applications, the awaited beneficial effects for women suffering from intrinsic rhabdosphincter deficiency-based mild-to-moderate SUI as well as, in men, to treat post-prostatectomy mild SUI.