southfloridasun.net • facebook.com/sfsuntimes • sfsuntimes@aol.com • Thursday, August 27, 2015 Page 1B
Urinary Incontinence is Curable after Prostate Cancer Treatment • Surgical therapy should be considered in men with post-prostatectomy stress urinary incontinence (SUI) that persists beyond the first postoperative year, or even earlier in men with severe symptoms
Dr. Angelo Gousse is the lead surgeon as part of a research team at the University of Miami and Precision Medical Devices developing a novel artificial urinary sphincter based on blue tooth technology.
WHAT IS URINARY INCONTINENCE? Urinary incontinence is estimated to affect 12– 17% of US males, with increasing prevalence associated with aging. Stress urinary incontinence (SUI) is defined by the International Continence Society as the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. Prostate surgery or radiation are the most common cause of male stress urinary incontinence. The good news is there is hope for patients who often are suffering in silence. Surgical therapy should be considered in men with post-prostatectomy stress urinary incontinence (SUI) that persists beyond the first postoperative year, or even earlier in men with severe symptoms. Other patients with severe urinary incontinence or with neurogenic bladder can also benefit from the treatment. The surgical device aims to prevent involuntary urinary leakage during storage by increasing bladder outlet resistance while allowing unimpeded flow during voluntary urination. The “Gold Standard” surgical treat-
ment, to date, is the artificial urinary sphincter. HOW THE DEVICE WORKS? The artificial urinary sphincter (AUS) is a surgically implantable device used to restore urinary control in men. Most commonly, the device is implanted in men who have sphincter or valve muscle damage following prostate surgery. The entire device is implanted inside the body in a brief outpatient surgical procedure lasting approximately one hour. With appropriate evaluation for the proper selection of candidates for the AUS, the long-term results in experienced hands are excellent. One of the leading artificial urinary sphincter implanters and authority in the country, Dr Angelo Gousse has performed more than 500 AUS implants, making him the number one implanter in Florida. COMPONENTS AND FUNCTION The AUS consists of three components: the cuff, which goes around the urethra, the pump, which goes inside the scrotum, and the balloon, which holds the fluid for the device (see figure).
The balloon is available in different pressure ranges and is filled with sterile salt water that is very safe even if it leaks. The device works hydraulically, with the cuff around the urethra staying closed at all times. When the person wants to urinate, the pump is squeezed and the cuff opens. Automatically, in 3-5 minutes, the cuff closes. TECHNIQUE OF IMPLANTATION IN THE MALE Insertion of the AUS is performed in a hospital operating room under either a general or a spinal anesthetic. Two small incisions are made: one in the groin area and the other between the scrotum and the rectum. The properly measured size cuff is placed around the urethra and the tubing from the cuff is passed up to the groin area. Recovery is less than 2 weeks. AN EXCELLENT TRACK RECORD The AMS 800 has been proven to be effective in the treatment of male incontinence following prostate surgery, and is considered the gold standard by most urologists. When using this device,
The artificial urinary sphincter (AUS) is a surgically implantable device used to restore urinary control in men. Most commonly, the device is implanted in men who have sphincter or valve muscle damage following prostate surgery. most men are dry, with only minor leaks or dribbles of urine, usually with strenuous exercise or exertion. Most men use one pad or less per day to manage these minor leaks. As with any medical procedure, the AMS 800 is not 100% effective in all patients. Some men may require additional protection. Serious complications are rare. Recently, the male synthetic sling called Advance has become available. Although longterm outcome data is currently being accumulated, the procedure appears to be most effective for mild to moderate male urinary incontinence. Urethral Bulking agents (Collagen and Durasphere, Teflon, Coaptite) for male incon-
tinence have fallen by the way-side for lack of efficacy. WHAT THE FUTURE HOLDS? Dr Angelo Gousse is the lead surgeon as part of a research team at the University of Miami and Precision Medical Devices developing a novel
artificial urinary sphincter based on blue tooth technology. The key features of the device include implant simplicity using less implantable components, no fluid in the device, and improved versatility for real-time pressure adjustments using a hand-held remote control device.
AMS 800 artificial urinary sphincter.
BLADDER HEALTH AND RECONSTRUCTIVE UROLOGY INSTITUTE
AVENTURA OFFICE.
MIRAMAR OFFICE.
Memorial Hospital Miramar Medical Office Building 1951 SW 172 Avenue, Suite 305 - Miramar, FL 33029 954-362-2720 Aventura Medical Office 21150 Biscayne Blvd, Suite 304 - Aventura, FL, 33180 (305) 606-7028 Fax (954) 362-2762 www.bladder-health.net