Ervin Kocjancic will be chairing the round table on Post-Prostatectomy LUTS at ICS 2016. This multidisciplinary event will highlight the issues from each disciplines perspective. Join us Wednesday 14th September from 13:00.
Dr. Sender Herschorn is Professor in the Division of Urology at the University of Toronto and attending Urologist and Head of the Urodynamics Laboratory at Sunnybrook Health Sciences Centre. In addition to being a past General Secretary of the ICS he was Chair of the Committee on Vesico-urethral Stenosis after Treatment for Prostate Cancer at the First International Consultation on Urethral Stricture Disease and Chair of the Committee on Surgery for Male Incontinence at the five International Consultations on Urinary Incontinence. During the multidisciplinary table on Post-Prostatectomy LUTS, Dr Hershorn is going to focus on challenging reconstructive surgery needed in cases of Post-Prostatectomy LUTS, such as recurrent and intractable stricture of the anastomosis and other functional complications associated with prostate cancer treatment.
Heather Moky, physiotherapist from the University of Illinois, Hospital and Health Science Systems says that “Pelvic floor muscle training is known as a first line treatment for urinary incontinence. We need to understand that pelvic floor muscles in men and women are the same, yet different". Questioning the bias in the literature and clinical practice when comparing these two will lead to a deeper understanding on how to be more effective when treating the male pelvic floor. In particular, after prostatectomy, one needs to identify the role of the urethral sphincter and how to compensate for the loss or damage that occurs. While at the same time, identifying others muscles that are impacted and addressing the loss of smooth muscle. Then the role of additional mechanisms that affect both the pelvic floor and incontinence needs to be examined. A variety of functional and psychosocial issues can impact continence and its recovery. Embracing the differences of the male and female pelvic floor and tailoring your treatment will lead to more independence and success with your patient.
Mandy Fader, Professor of Nursing from University of Southampton will talk about Intermittent catheterisation, products and devices. Urinary incontinence is common in the early weeks and months after prostatectomy and varies widely from light to very heavy leakage. Although less common incomplete bladder emptying can also occur. Yet despite the availability of a wide range of products such as pads, penile clamps, sheaths and intermittent catheters -- men report feeling uninformed and ill-prepared to deal with incontinence and often don’t have ready access to advice or appropriate products. Mandy says that “in this roundtable we shall discuss choices of catheter for intermittent catheterisation; how and when men should be prepared for incontinence; what products are available and the evidence base for their use.”
Myung-Soo Choo, Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea will review the poor prognostic factors for post-prostatectomy incontinence surgery. Artificial urinary sphincter (AUS) or alternative male slings are the recommended treatments for PPI patients who have not responded to 6–12 months of conservative management. However, Myung-Soo Choo, explains that “a substantial portion of patients who receive the PPI surgery are inevitably confronted with the treatment failure.” Previous studies consistently have reported that significantly worse outcomes in patients with radiation therapy, severe symptoms, or bladder neck contracture. The degree of baseline urine leakage, as measured by pad weight, can affect the outcome of sling surgery. The retroluminal sling has been associated with reduced success rates in men with severe incontinence (>200g leakage daily). Sling placement is generally ineffective following prior AUS explanation, which typically causes a poorly compliant and relatively noncompressible fibrotic urethra. Prior radiotherapy has been reported as a risk factor for sling failure because adequate urethral tissue compliance is necessary for successful urethral compression. AUS implantation after radiotherapy showed lower success rates and higher revision rates in some studies due to a higher incidence of infection and erosion. Preoperative urodynamic parameters did not correlated with worse surgical outcomes except for the reduced bladder compliance, it can still be useful for detecting bladder dysfunction to allow early intervention and for counselling.
With urologist, nurses and physiotherapists coming together to discuss this relevant topic, surely its one not to miss!