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Dr. Abdullah Ahmad Ghazi (R5)KSMC
19-12-1432
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Estimated as:5-69% of women1-39% of men.
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Age. LUTS. Infection. Functional and cognitive impairment. Neurological disorders. Prostatectomy.
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Sphincter-relatedPostoperative
Post-prostatectomy for benign disease Post-prostatectomy for prostate cancer Post radiotherapy, brachytherapy, cryosurgery,
HIFU for prostate cancer Post cystectomy and neobladder for bladder
cancerPost-traumatic
After prostato-membranous disruption and urethral reconstruction
Pelvic floor traumaUnresolved paediatric UIExstrophy and incontinent epispadias
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Bladder-relatedRefractory UUI (overactive bladder)Reduced capacity bladder
FistulaeUrethro-cutaneousRecto-urethral
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Hx Ex Urine analysis PVR Voiding diary. Pad test. Renal profile. U.cystoscopy. Image (U/S, VCUG, IVP). UDS.
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BPH Incidence of UI is similar after (TURP, TUIP,
Holium enucleation and open surgery). Pr Ca
Reported 5-48%.
Assessed by:Numbers of pads and their wetness.Social impairment.Bothersomeness.
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Total control without any pad. Leakage:
No pad but loss of few drops of urine ‘underwear staining’.
None or 1 pad ‘safety pad’ per day.
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Age at surgery. Prostate size. Co-morbidity. Nerve sparing surgery. Bladder neck stenosis. Tumour stage (possibly related to
surgical technique) Preoperative bladder and sphincter
dysfunction.
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How long to wait ?
Artificial urinary sphincter (AUS) success rate 59-90%.
Male slings 58%.Bulking agents, early failure 50%.
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Cognitive impairment.
Dexterity restriction.
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?
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Risk is 0-18.9%, increase with time.
More as adjuvant therapy, or Hx of TURP.
AUS post XRT associated with more complications.
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Perineal compression slings (limited evidence).
Injectable agents (not successful).
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Brachytherapy 0-45%. Cryotherapy 0-5%. HIFU
Rx: AUR Injectable material not successful.
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Cause of incontinence after AUS:
Alteration in bladder function.Urethral atrophy.Mechanical malfunction.
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