ABSTRACT
The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some 'high-risk' populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
ABSTRACT
The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some "high-risk" populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
Subject(s)
Female , Humans , Male , Erectile Dysfunction/surgery , Penile Implantation , Prosthesis Implantation/methods , Reoperation , Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/surgery , Urinary Incontinence, Stress/surgery , Urinary Sphincter, ArtificialABSTRACT
Objective: To make a retrospective control study of the curative effects of Four sacral needles method and conventional acupuncture therapy on female stress incontinence. Methods:A treatment group was treated by Four sacral needles method, in which four sacral points were electroacupunctured with special insertion of needles to excite the pudendal nerve and induce the rhythmic contraction of the pelvic floor muscles, thereby increasing the strength of the pelvic floor muscles and improving ability in urinary continence. A control group was treated by conventional acupuncture therapy, in which corresponding points were acupunctured according to syndrome-based classification. Results: In the 31 cases of the treatment group treated by Four sacral needlesmethod, 100% symptom improvement occurred in 22(71.0% )after an average of 21 treatments (3-63treatments). In the 34 cases of the control group treated by conventional acupuncture therapy, 100%symptom improvement occurred in 0 after 30 treatments. The curative effect was better in the treatment group than in the control group(p＜ 0.01).The curative effect improved with an increase in the number of treatments in the treatment group. Conclusion: Four sacral needles method is more effective than conventional acupuncture therapy in treating female stress incontinence.