9/16/2013. Satisfying Solutions: Male Incontinence. Types of Incontinence. Men s Health Solutions for Erectile Dysfunction and Incontinence

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1 Men s Health Solutions for Erectile Dysfunction and Incontinence Dr. Karl J. Kreder and Dr. Brad A. Erickson Satisfying Solutions: Male Incontinence What is it? Male urinary incontinence is usually caused by a damaged sphincter, the circular muscle that controls the flow of urine out of the bladder When damaged (often the unavoidable result of prostate cancer surgery), the sphincter cannot squeeze and close off the urethra, which causes urine to leak Types of Incontinence Stress Urinary Incontinence (SUI) Leakage during a physical activity like lifting, exercising, sneezing and coughing Most common following prostate cancer surgery Urge Incontinence Leakage associated with an overwhelming need to urinate Gotta go, gotta go!!! Overflow Incontinence Leakage when your bladder never completely empties Total Incontinence Leakage when the urinary sphincter muscle is completely deficient 1

2 How does the process work? In men, the urinary sphincter muscle is located below the prostate The sphincter muscle surrounds the urethra When the sphincter muscle tightens, it holds urine in the bladder When it relaxes, the bladder contracts and the urethra opens, allowing urine to flow outside the body When the sphincter muscle is damaged, it cannot close off the urethra What causes incontinence? Prostate cancer surgery: radical prostatectomy or TURP Conditions such as diabetes, multiple sclerosis, Parkinson disease or stroke Pelvic trauma Birth defects Am I the only one suffering from incontinence? NO! 55 million men worldwide 5 million men in the U.S. Rate of incontinence after prostate surgery ranges from 2.5% up to 69% 2

3 Treatment Options for Stress Incontinence Behavioral Modification and Medication Decrease fluid intake Urinate frequently Avoid caffeine, alcohol Avoid activity that increases intra-abdominal pressure Pelvic floor muscle strengthening exercises No FDA approved medication for stress incontinence in men Absorbent Products: Pads, Diapers Is this a satisfactory solution for you? Are these the best solution? How often do you need to change them? Do you have skin irritations and rashes? Are they inconvenient? 3

4 Absorbent Products: Pads, Diapers Cost is a factor Cost Comparison of Wearing 5 Pads a Day for 10 Years Entrust Active Style Pads Undergarments $0.52 each $0.99 each Coveen Drip Collectors $1.05 each Depends Undergarments $0.52 each Devices: Clamps Cunningham Clamp, C3 Clamps Some Advantages Non-medical, non-surgical Easy to use Functional Inexpensive Some Disadvantages Bulky Scarring Painful Skin and tissue problems Devices: Catheters External vs. Internal Some Advantages Functional Some Disadvantages Attached to a bag Increased risk of infection 4

5 Periurethral Injections Macroplastique Success rate is 26% at 6 months Surgical Options AdVance Male sling Artificial urinary sphincter AdVance Male Sling: Benefits Outpatient surgery May be performed under spinal or general anesthesia Often no catheter necessary upon discharge No device activation required Immediate improvement Restored dignity and quality of life 5

6 AdVance Male Sling AdVance is not for people with: Urinary tract infections Blood coagulation disorders Compromised immune systems or any other condition that would compromise healing Renal insufficiency and urinary tract obstruction Artificial Urinary Sphincter The gold standard for treatment of moderate to severe incontinence A cuff wraps around urethra and inflated (closed) at rest A pump in the scrotum deflates (opens) the sphincter and allows urination Artificial Urinary Sphincter Outpatient procedure Effectively gives most men the ability to achieve continence 92% of patients would have the device placed again 96% of patients would recommend it to a friend Device is placed completely inside the body, providing simple, discreet urinary control Published clinical data shows long-term effective results 6

7 AMS 800 Artificial Urinary Sphincter The AMS 800 is not for men who: are not good candidates for surgical procedures with spinal or general anesthesia have an irreversibly blocked lower urinary tract have unresolvable detrusor hyperreflexia or bladder instability have a known allergy or sensitivity to rifampin, minocycline or other tetracyclines You Should Know As with most surgical procedures, inherent risks are present and potential adverse reactions may occur. Although rare, some of the most severe risks include infection, erosion, and perforation. Some potential adverse reactions to surgical procedures to correct incontinence include: Pain/discomfort/irritation Inflammation Incomplete correction of urinary incontinence Urinary tract infections/obstruction/retention Urge symptoms Difficulty with urination Talk to your doctor about the benefits and risks before moving forward with any treatment option. Summary Incontinence is a common problem Some treatments are more effective than others Surgical treatments offer proven, longterm solutions Talk to your urologist 7

8 Satisfying Solutions: Erectile Dysfunction (ED) What is it? The inability to maintain an erection firm enough to have sexual intercourse How prevalent is it? 1 in 5 American men Over 30 million American men Over 150 million men worldwide Causes: 90% physical, 10% psychogenic Main Physical Causes of ED 3% 1% 5% 6% 15% Medication 30% Diabetes 40% Vascular Vascular Diabetes Medication Pelvic Surgery, Radiation or Trauma Neurological Causes Endocrine Problems Other Degree of ED by Age Prevalence of ED by Age and Severity (%) 100% 80% 60% 40% Severe Moderate Mild or Mild/Moderate 20% 0%

9 Do you have to live with ED? NO! Nearly every man can be successfully treated. Treatment Options for ED Oral Medications Not effective in approximately 30% of cases Work only in response to sexual stimulation Must take at least ½ hour to 1 hour before anticipated sexual activity Viagra can remain effective for up to 4 hours; Cialis can be effective up to 36 hours High fat meals can affect absorption of Viagra Estimated cost per pill: $15-$30 9

10 Common side effects Headache Facial flushing Runny nose Upset stomach Body aches Oral Medications What to watch out for Cannot take with NITRATES Precautions with medications for prostate problems If you have serious liver or kidney problems Vacuum Erection Device Some Advantages On-demand use Non-invasive Safe and effective Drug free Cost-effective Some Disadvantages Cumbersome Unnatural erection Erection is not warm to the touch Bruising/burst blood vessels Penile pain/discomfort Numbness Delayed ejaculation Urethral Suppository: MUSE Small, medicated pellet placed in the tip of the penis; opens blood vessels to increase blood flow to the penis Some Advantages No needles or injections Erection within 10 to 15 minutes Some Disadvantages Penile pain and burning Inadequate penile ridigity Must be refrigerated Cost is approximately $25 per application Patients with poor manual dexterity/vision or severe obesity may find administration difficult 10

11 Penile Injection Therapy Some Advantages Effective Onset of erection within 5-20 minutes Some Disadvantages Risk of erection lasting 4 hours or more (priapism) Possible bleeding at injection site Requires training Bruising, prolonged erection, cavernosal fibrosis Can cause Peyronie s disease Poor long-term tolerability Fear of sticking needle into penis Penile Implants Ideal for men who have tried other treatments without success On the market for over 30 years Over 300,000 implants to date High patient and partner satisfaction Penile Implant vs. Other Options n=22 n=31 n=32 11

12 3-Piece Inflatable Penile Implant Some Advantages Totally concealed in body Like a natural erection Device is inflated to provide rigidity and deflated for concealment Erection longevity is controllable When deflated, the cylinders are soft and flaccid Expands in girth (all AMS 700 cylinders) and length (AMS 700 LGX and Ultrex cylinders) AMS 700 with InhibiZone is the only inflatable penile prosthesis with clinical evidence showing a significant reduction in the rate of revision due to infection Implants are Highly Recommended These recommendations pertain to the AMS two-piece inflatable prosthesis Benefits Offers a long-term solution to ED Provides the ability to have an erection anytime you choose Allows for greater spontaneity have sex when the mood strikes Enables you to maintain an erection as long as you desire Eliminates the need for costly pills or shots Feels natural during intercourse Does not interfere with ejaculation or orgasm 12

13 Possible Risks Will make latent natural or spontaneous erections as well as other treatment options impossible If an infection occurs, the prosthesis may have to be removed May cause the penis to become shorter, curved or scarred There may be mechanical failures of the prosthesis Pain Insurance Coverage Most insurance companies, including Medicare, cover penile implant Medicaid/Iowa Care do NOT Summary ED is a common problem Nearly every man can be successfully treated for ED Penile implants offer a dependable, longterm solution Talk to your partner Talk to your urologist 13

14 Men s Health Assessment Questions? 14