Stress Urinary Incontinence Archives

Female SUI: Full-length MUS, PVS

by Christopher E. Wolter, MD | Dec 2024

Christopher E. Wolter, MD, focuses on advancements in the surgical management of female stress urinary incontinence, emphasizing the evolving role of different sling techniques. In this 11-minute presentation, Wolter highlights midurethral slings (MUS), specifically retropubic slings, widely accepted as the gold standard.

The discussion includes photographic, ultrasound, and drawn images to illustrate correct sling placement. Wolter also discusses patient selection criteria for different sling options. He notes that addressing the stress component first often helps alleviate urgency; however, data suggests that urgency symptoms resolve in 66% of cases when treated with mid-urethral slings. Finally, Wolter acknowledges the importance of patient counseling and education, to assure sling success.

Management of Posterior Urethral Strictures

by Shyam S. Sukumar, MD | Oct 2024

Shyam S. Sukumar, MD, provides an in-depth exploration of managing posterior urethral strictures, focusing on the anatomical and procedural complexities unique to posterior cases. Throughout this 16-minute presentation, Dr. Sukumar shares drawings and images to illustrate the nuanced approaches necessary for managing posterior stenosis.

Stress incontinence becomes a crucial consideration, especially in patients with radical prostatectomy histories. Sukumar emphasizes the need for a comprehensive preoperative assessment to accurately gauge stricture extent and plan the repair approach. For surgical reconstructions, Dr. Sukumar highlights differing procedures from anastomotic urethroplasty and flap procedures, depending on patient need.

Sukumar believes posterior urethral stricture repair demands flexibility in approach and a readiness to adapt intraoperatively based on the challenges presented. Mastery of various reconstructive techniques and a patient-specific approach ensure optimal outcomes, especially in these anatomically and procedurally demanding cases.

FRU Discussion

by Brian J. Flynn, MD and Alan J. Wein, MD, PhD (hon), FACS | Sep 2024

Brian J. Flynn, MD, and Alan J. Wein, MD, PhD (Hon), FACS, discuss the evolution of functional urology.

In this 16-minute discussion, Dr. Wein emphasizes the holistic approach to functional urology, which encompasses all measures to restore normal bladder function, whether through medication, pelvic floor therapy, or surgery. Of note is his stance against dividing male and female urology, advocating for an integrated approach that addresses dysfunction across genders.

Dr. Wein and Dr. Flynn discuss the overlap between storage and voiding dysfunctions, like stress and urge incontinence, which often coexist. Dr. Wein shares insights on how treating one issue can sometimes alleviate the other, though the relationship remains unclear. He stresses the importance of a unified, simplified approach to diagnosis and treatment.

Other colleagues attending the discussion provided perspective and emphasized collaborative, team-based approaches to functional urology. A urogynecologist highlighted how gynecologists primarily manage female pelvic health and storage issues, while a pediatric urologist underscored the importance of standardized nomenclature and communication across specialties.

Best Treatment for Male Incontinence: Sphincter

by Alexander Gomelsky, MD, FACS | Feb 2021

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.

Best Treatment for Male Incontinence: Sling

by Brian S. Christine, MD | Feb 2021

In the first part of this urologic debate, Brian S. Christine, MD, Director of Prosthetic Urology and Men’s Sexual Health at Urology Centers of Alabama in Birmingham, argues that the sling is the best treatment for post-prostatectomy stress urinary incontinence in men. He goes over how to select the right candidates for a sling, the pre- and post-operative procedural steps, and the resulting success rate. Dr. Christine notes that slings are best used in patients with mild to moderate stress urinary incontinence as determined by a severity grading system. He considers two options for determining incontinence severity, the pad test and the standing cough test, observing that the latter is preferable given that it is done in-office versus by the patient at home. Dr. Christine then provides a detailed explanation of the surgical steps and technique using an AdVance XP male sling. He concludes that the sling, when used on the ideal candidate with a standing cough test grade of 0, 1, or 2, results in a post-operative success rate of 82-83% of patients who are dry or pad-free. Alexander Gomelsky, MD, FACS, argues in favor of using an artificial urinary sphincter in the second part of the debate here.

Quality of Life Outcomes Following Urethroplasty

by Chris M. Gonzalez, MD, MBA, FACS | May 2018

Chris Gonzalez, MD, MBA, FACS, discusses the development of Patient Reported Outcome Measures (PROMs) to evaluate patient-perceived success of urethral stricture treatments. He describes the Male Sexual Health Questionnaire (MSHQ) and the International Index of Erectile Function (IIEF) and the needed improvement in these types of questionnaires in the future.

Topic: Stress Urinary Incontinence