Alexander Gomelsky, MD, FACS, presented “Best Treatment for Male Incontinence: Sphincter” during the Innovations in Urologic Practice 2020 virtual conference in September 2020.

How to cite: Gomelsky, Alexander. “Best Treatment for Male Incontinence: Sphincter.” September 26th, 2020. Accessed Jul 2024. https://grandroundsinurology.com/best-treatment-for-male-incontinence-sphincter/

Best Treatment for Male Incontinence: Sphincter – Summary

In the second part of this urologic debate, Alexander Gomelsky, MD, FACS, B.E. Trichel Professor and Chair of the Department of Urology at LSU Health Shreveport, argues that artificial urinary sphincter (AUS) is the best treatment for post-prostatectomy stress urinary incontinence. Dr. Gomelsky first describes possible surgical complications and how to set patient expectations, then reviews data on AUS and the male sling, and finally contrasts the benefits of AUS against the sling. In comparison with the sling, which is best used in patients with mild incontinence, AUS can handle any degree of incontinence including severe and persistent presentations. Noting that AUS can also be used in patients who have undergone radical therapy, those with prior urethral stricture or bladder neck contracture, and those who have undergone urethral bulking, Dr. Gomelsky suggests that AUS outperforms the sling in all scenarios. Additionally, data suggests that a sphincter would be placed after a sling failure, further underscoring its utility. Brian S. Christine, MD, argues in favor of using a sling in the first part of the debate here.

About the Innovations in Urologic Practice 2020 virtual conference:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Gomelsky presented this talk virtually at the 2020 conference.

ABOUT THE AUTHOR

Dr. Alex Gomelsky received dual BA degrees in Russian and Natural Sciences from Johns Hopkins University and his MD from the University of Maryland School of Medicine. He completed his urology residency at Northeastern Ohio Universities College of Medicine, followed by a fellowship in female urology at Vanderbilt University. He joined the LSU Health Shreveport Department of Urology in 2004.

Dr. Gomelsky is the B.E. Trichel Professor and Chair in the Department of Urology. He has served as Residency Program Director since 2011 and is the Director of the Section of Female Urology, Neurourology and Pelvic Reconstructive Surgery. He has served on the AUA SUI Guidelines Committee and the ABU/AUA Written and Oral Examination Committees. Dr. Gomelsky received the 2012 Paul Zimskind Award from SUFU for contributions to the organization and served as a Southeastern Section Representative to the AUA Leadership Program from 2008 to 2010. He has also served as the President of the Louisiana State Urological Society and was General Faculty President of LSUHSC-Shreveport in 2014. He has published over 100 peer-reviewed manuscripts and book chapters, and is a popular lecturer and contributor to meetings and panels. He is passionate about resident and medical student education and his clinical research interests entail outcomes in incontinence and pelvic organ prolapse surgery.