Stress urinary incontinence negatively impacts on a person’s quality of life and can be difficult to manage. Andrew Cohen, M.D., details innovation in the treatment of stress urinary incontinence for men.
I'm gonna take a moment to talk to you today about stress urinary incontinence treatment. As you know, stress urinary continence can be a devastating problem for both men and women as they try to go through life, dealing with can be quite dramatic amounts of urinary leakage. Um This is a huge detriment to their quality of life and I feel quite privileged to be working here at the brady where we have a team of experts who are dedicated to the research and innovation in this subject area so that we can really help our patients get back on their feet in particular. Today, I'm going to talk to you about male urinary stress incontinence which is an unfortunate consequence sometimes from prostate cancer treatment or the treatment of benign prostatic hyperplasia. Here at the brady. We've been very lucky to have collaborations across the country and I'm going to talk about some of them today. One of them is our wonderful relationship with the american Urological Association and through them we've been able to have access to wonderful data set. Uh And through that lens can provide you with a contemporary view of what treatments are currently being used for male stress urinary incontinence. As you can see here. The most popular choice of treatment is the artificial urinary sphincter. This is followed close behind by male urethral slings. And then a small percentage of men are getting bulking agents injected into the urethra. This state is also very interesting because you can see the trends in elective surgery going down as the covid pandemic commences. So let's talk a little bit more about the artificial urinary sphincter as you know, this device has been around for a number of decades and it involves three pieces, one that goes around the urethra to provide some compression, a reservoir where the fluids is maintained for use of the device and essentially a button that is placed under the skin that patients interact with. And one real reluctance on the part of patients that we encounter is the sense that this is a large surgery requires admission in the hospital and overnight stay and a urethral catheter, which is universally hated. Um and so I've been able to put together a cross country collaboration to really demonstrate that maybe all of those things are not needed and we can provide this care to patients in a less invasive way without a catheter and a hospital stay. And so this data demonstrates that there is no difference in surgical site infections, in the risk of urinary tract infections or in the risk of urinary retention after the placement of an artificial urinary sphincter if a patient has or does not have a catheter in an overnight stay in the hospital. So this has been fundamental in changing the way that we approach sphincter surgery here at the brady. Moreover, this data shows what many others across the country have shown as well, which is this device is not entirely reliable and there is a fair number of patients who require revision surgery. Indeed, the a U. A. Recognizes this and one of our very guideline statements indicates that if a man is considering a sphincter surgery, they need to understand that they may require mechanical revisions or surgical revisions for other causes. And many individuals are our team here and others across the country have looked into this and have tried to sort of decide, you know which part of the device is sort of the most faulty. Can you simply revise one part or you have to revise all the parts? But this whole conversation really brings up a bigger topic which is maybe there's room for innovation here and maybe we need to think about a different type of way to treat men with incontinence. So luckily because of the wonderful scientists and the collaboration that's possible across campus here, I've been able to work with the extreme Materials Institute and innovate on creating a new way to potentially treat male stress and continents. And this is a device that is very early in its investigations but uses a unique metal that changes its confirmation with temperature changes or electrical currents. And we're hoping that we can prove with continued research and innovation that this methodology may offer a treatment for stress during incontinence in men that is much more reliable and safe