International Functional and Reconstructive Urology Update Archives

Male SUI: Passive/Adjustable Devices

Posted by Brian J. Flynn, MD | Apr 2024

Brian J. Flynn, MD, delves into the categorization and management of devices for male stress incontinence, focusing on both passive and active options.

In this 20-minute presentation, he discusses passive devices, such as the advanced sling and newer adjustable slings like ARGUS and ATOMS, which offer various solutions for managing low-to-moderate leakage in non-radiated patients. He also introduces active devices, particularly the artificial urinary sphincter (AUS), but cautions that cognitive and dexterity issues often develop over time in long-term users. This has spurred interest in creating adjustable AUS devices that reduce the need for manual operation, potentially leading to fewer complications like urethral erosion.

Dr. Flynn then transitions to sharing a ProAct implantation technique, providing images and videos of procedures. He gives step-by-step instructions, beginning with optimal operating room setup. To provide the best learning opportunity, he also shares images of poor device placement and discusses correction, stressing the importance of learning from the mistakes of others.

Bladder Microbiome and Recurrent UTIs: Preventing Those Nasty Buggers

Posted by Suzette E. Sutherland, MD, MS, URPS | Apr 2024

Suzette E. Sutherland, MD, MS, URPS, addresses the role of the microbiome in recurrent urinary tract infections (UTIs). She begins this 26-minute presentation by reviewing the bladder microbiome, noting that microbes support immune function and maintain the integrity of the bladder lining. She then transitions to prevention and treatment of the condition.

Non-antibiotic prevention strategies are discussed, focusing on hydration, cranberry supplements, estrogen, and probiotics. Probiotics are emphasized for their role in reducing UTI recurrence, but Sutherland stresses the importance of proper diagnosis and judicious antibiotic use to avoid contributing to antibiotic resistance. Catheter-associated UTIs are also addressed, with a preference for clean intermittent catheterization and bladder irrigation with gentamicin in severe cases. Overall, Dr. Sutherland advocates for a conservative, evidence-based approach, using antibiotics only when necessary to preserve the efficacy of these crucial medications.

Optimizing Success in Penile Implant Surgery

Posted by Jay Simhan, MD, FACS | Apr 2024

Jay Simhan, MD, FACS, focuses on optimizing outcomes in penile implant surgery, emphasizing technical performance and perioperative management. In this 17-minute presentation, Simhan suggests that reconstructive urologists should focus on patient outcomes in addition to technical aspects of surgery.

Simhan outlines a multimodal approach to pain management, combining neuropathic pain control, anti-inflammatories, and intraoperative pain blockades rather than relying on opioids alone. Further, he discusses the challenges of managing patients with priapism-related erectile dysfunction, highlighting the difficulties of delayed penile implantation in these cases. The presentation also critiques existing guidelines for antibiotic prophylaxis in penile implants, noting that the American Urological Association’s (AUA) recommendations fail to cover certain pathogens like anaerobes and fungi.

Dr. Simhan stresses the importance of collaboration across institutions to address these complex issues. He introduces the Prosthetic Urology Multi-institutional Partnership (PUMP), a coalition of urologists who address penile implant questions.