Urethral Compression For The Treatment Of Postprostatectomy Urinary Incontinence: Is History Repeating Itself?
April 11, 2007 – 4:11 pm | posted in Medical Devices, Urology / NephrologyUroToday.com- Recently, an editorial by Shlomo Raz and colleagues from UCLA raised concerns over current surgical choices for the treatment of post-prostatectomy incontinence. The editorial is published in the February 2007 issue of European Urology.
Compressive devices for male incontinence were first described in 1750 and there has been an evolution of the use of increased urethral resistance for the treatment of SUI in the male. Fixed compressive devices confer continence by obstructing outflow, but this resistance can be overcome with sufficient elevation of intra-abdominal pressure. Dynamic compressive devices use variations in pressure that can be modified to achieve continence. The classic dynamic device is the AMS artificial urinary sphincter.
The modern era of implantable fixed compressive devices has evolved from Berry’s 1961 acrylic prosthesis. In 1968, Kaufman described three fixed bulbar compressive devices. The Kaufman I consisted of crural crossover to compress the bulbar urethra. The Kaufman II avoided detachment of the crural bodies and merely attached the bodies in the midline over the urethra to provide resistance. In the Kaufman III, an implantable silicone gel prosthesis was used to confer bulbar compression. The pendulum eventually swung back to the dynamic compression devices and the fixed devices such as the Kaufman fell out of favor.
Various sling procedures have also been used for the treatment of post-prostatectomy SUI. Most recently, the Invance male sling, produced and aggressively marketed by American Medical Systems, has become a commonly performed procedure. So it is interesting that the trend has again become performing a procedure which relies on fixed urethral compression. Raz comments that this is concerning considering a past experience of failures. The long-term outcomes of these procedures will be instrumental to assess these newer compressive techniques. It does appear that if the long-term results mirror the short-term results, that the male sling will likely be effective in patients with only mild to moderate incontinence.
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