Topic: Incontinence

Current Diagnosis and Management of Female Stress Incontinence

Alexander Gomelsky, MD, FACS, B.E. Trichel Professor and Chair in the Department of Urology at LSU Health Shreveport, discusses current guidance regarding the diagnosis and surgical management of female stress incontinence (SUI). He frames his presentation around the 2017 AUA/SUFU Guidelines which, while based on more high-level evidence than prior guidelines, still use an index patient who does not match the majority of women urologists are likely to see for SUI. Dr. Gomelsky particularly focuses on this limitation, noting for instance that doing urodynamic testing, which does not appear to be useful for index patients, can help urologists meet the particular needs of non-index patients (e.g., women of advanced age, women with high BMIs, women suffering from recurrent/persistent SUI, women who have had prior surgery for SUI, etc.). He further discusses both the benefits and adverse events associated with different available surgical therapies for treating SUI, emphasizing that while mesh for transvaginal repair of pelvic organ prolapse has been banned, evidence still supports mesh placed abdominally for pelvic organ prolapse, as well as midurethral slings for SUI.

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Innovation in the Treatment of Male Urinary Incontinence

Culley C. Carson III, MD, Emeritus Rhodes Distinguished Professor in the Department of Urology at the University of North Carolina School of Medicine, discusses innovations in the treatment of male urinary incontinence. He outlines different treatments and their various pros and cons, including some cutting-edge technology that is not yet available in the US. He also goes over innovations, which still need to be made in order to further improve certain technologies like the artificial urinary sphincter. He highlights how important it is to come up with a more cost-effective model because, currently, artificial urinary sphincters are extremely expensive. There are also several significant causes of revision surgery for artificial urinary sphincters, demonstrating the need for further innovation. Dr. Carson also emphasizes the importance of customizing the pumps to individual patients, and goes over current research intended to improve patient outcomes.

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Stress Urinary Incontinence: Non-Mesh Alternatives

Una Lee, MD, FPMRS, urologist and researcher at Virginia Mason Medical Center, reviews the evidence on non-mesh alternatives for stress urinary incontinence (SUI). She provides an overview of the causes of female SUI, presents an effective treatment tree addressing both overactive bladder and stress incontinence, and discusses treatment options. Dr. Lee encourages physicians to consider how they present treatment decisions in order to allow patients to make the choice that fits best for them. In addition to covering all possible risks and benefits, she advises physicians to also educate patients on their condition and help manage their expectations for treatment outcomes.

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Geriatric Considerations in Urinary Incontinence and Overactive Bladder (OAB)

Una Lee, MD, FPMRS, a urologist at the Virginia Mason Medical Center, discusses concepts physicians should consider when managing urinary incontinence and overactive bladder (OAB) in geriatric populations. First, Dr. Lee reviews the “5 M’s”: mind, mobility, medications, multi-complexity, and what matters most to the patient, or care goals/preferences. Additionally, she addresses the role of frailty in older adults, which is associated with increased risk of poor health outcomes. Lastly, she reviews data about the association of anticholinergic medication use and dementia.

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HIFU is not Ready for Prime Time

Erik P. Castle, MD, argues that using high intensity focused ultrasound (HIFU) to treat prostate cancer, as the technology stands today, results in too many negative quality of life outcomes for patients. Therefore, HIFU is not ready to be a standard of care in urological practices.

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