1. Your Treatment Options For Male Urinary Incontinence

2. Physician Presenter Disclaimer Products, services or therapies discussed in this presentation may be subject to regulatory approval / clearance and therefore labeling may change. Opinions given during this presentation are my personal, professional opinion. (Note to physician: Review disclaimer and insert appropriate language and/or content changes to fit your individual circumstances)

3. Urinary Function and Incontinence

4. Important Male Anatomy 1 The bladder stores urine Urine exits the body via the urethra Part of the urethra is surrounded by muscles called sphincter muscles The sphincter muscles remain contracted in order to keep urine in the bladder 1.National Institute of Health (NIH) Website. http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/YourUrinary.pdf. Accessed 07/23/12.http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/YourUrinary.pdf. Accessed 07/23/12 Bladder Sphincter Urethra

5. Important Male Anatomy 1 In order for urination to occur, the bladder contracts and the sphincter muscles relax When the sphincter muscles relax, urine is able to exit the body via the urethra 1. National Institute of Health (NIH) Website. http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/YourUrinary.pdf. Accessed 07/23/12. Bladder Sphincter Urethra

6. What is Incontinence and What are the Types of Incontinence? 2 Types of Incontinence: Stress Urinary Incontinence (SUI) – Complaint of involuntary leakage on effort or exertion, sneezing or coughing. Urge Incontinence – Leakage accompanied by or preceded by urgency (an overwhelming need to urinate…Gotta go, gotta go!) Mixed Incontinence – Leakage associated with urgency AND effort, exertion, sneezing and coughing 2. Abrams P., Andersson, K.E., Birder, L., Brubaker, L., Cardozo L., Chapple, C., et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse, and Fecal Incontinence. Neurourology and Urodynamics. 2010; 29:213-240. Incontinence is the complaint of any involuntary loss of urine.

7. What Causes Incontinence? Prostate Cancer Surgery 3 Conditions such as: 3 Diabetes Multiple sclerosis Parkinson’s disease Stroke Pelvic Trauma or Surgery 4 3. National Institute of Health (NIH) website. http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/uimen.pdf. Accessed 7/9/12 4. Sandhu, J. Treatment options for male stress urinary incontinence. Nat. Rev. Urol. 2010;7:223.

8. Why Treat Incontinence? 5 Incontinence can cause men mental distress, limit social activities and is inconvenient. Mental Distress Feeling dirty and less confident Fear of smelling or discovery Feelings of depression and negative view on health 6 Social Restrictions Some limited travel and attendance at social events Some problems lifting heavy objects, or wearing certain clothing Inconveniences Extra laundry and expense Skin irritation and sleep disturbances 5. Hunskaar, S., Sandvik, H. One hundred and fifty men with urinary incontinence. Scanc J Prim Health Care. 1993;11:193-196. 6. Ko, Y., et al. The Impact of Urinary Incontinence on Quality of Life of the Elderly. Am J of Managed Care. 2005:103-111.

9. Who Suffers From It? Worldwide, over 43 million men suffer from urinary incontinence (stress, mixed and urge) 7 3.4 million men (17%) in the U.S. ages 60+ suffer from incontinence 8 Rate of incontinence ranges from 2.5% up to 69% after prostate surgery 9 7. Irwin, D, Kopp, Z., Agatep, B., Milson, I., Abrams, P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU International. 2011;108:1134. 8. Anger, JT., Saigal, CS., Stothers, L., Thom, DH., Rodriguez, LV., Litwin, MS. The Prevalence of Urinary Incontinence Among Community Dwelling Men: Results from the National Health and Nutrition Examination Survey. J Urol. 2006;176:2103-2108. 9. Tewari AK, et al. Anatomic Restoration Technique of Continence Mechanism and Preservation of Puboprostatic Collar: A Novel Modification to Achieve Early Urinary Continence in Men Undergoing Robotic Prostatectomy. Adult Urology. 2007;69:726-731.

10. Management and Treatment Options For Male Urinary Incontinence

11. Behavioral Modification and Medication Limit fluid intake 4 Avoid bladder irritants such as caffeine and alcohol 4 Pelvic floor exercises – “kegels” 4 Currently, no medications are approved to treat stress urinary incontinence in men 10 4. Sandhu, S. Treatment Options for Male Stress Urinary Incontinence. Nat. Rev. Urol. Apr 2010;7-4:222-8. 10. Bauer, RM, Gozzi, C., Hubner, W., Nitti, VW, Novara, G., Peterson, A, et al. Contemporary Management of Postprostatectomy Incontinence. Eur Urol. June 2011;59-6:985-96.

12. Absorbent Products Reusable or disposable pads or garments worn on the body or placed on furniture to absorb urine. Side Effects 11 Skin Irritation/Discomfort Leakage Movement after in place Odor Not discreet 11. http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-undergarments.html. Accessed 07/23/12.

13. Penile Clamps 12 A clamp is placed around the penis, applying pressure on the urethra, which prevents the involuntary loss of urine. Side Effects Scarring Pain Skin and tissue problems 12. http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-penile-clamps.html. Accessed 7/20/12.

14. Penile Catheters – External and Internal 13 External: Special condom that fits over the penis and is attached to a tube that collects urine. Internal: Catheter which remains in place continuously allowing the bladder to drain. Side Effects Urinary tract infection Damage to penis from friction with the condom Urethral blockage 13. http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-condom-catheter.html. Accessed 7/20/12.

15. Bulking Agents Bulking agents are substances that are injected into the urethral tissue to increase tissue bulk around the urethra. 4 Side Effects Multiple injections are usually needed 14 Results deteriorate over time 14 4. Sandhu, S. Treatment Options for Male Stress Urinary Incontinence. Nat. Rev. Urol. Apr 2010;7-4:222-8. 14. Herschorn S, Bruschini H, Comiter C, Grise P, Hanus T, Kirschner-Hermanns R, Abrams P; Committee of the International Consultation on Incontinence. Neurourol Urodyn. 2010;29-1:179-90.

16. Surgical Treatment Options

17. Male Slings The synthetic sling supports the urethra and is designed to restore normal bladder control; functions as a “hammock” during physical activity 15 Side Effects 16 Pain and inflammation Bleeding and irritation at wound site Urethral or tissue erosion 15. Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM. Treatment of post-prostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3 year follow up. Eur Urol. Feb. 25, 2012. 16. Surgical Procedures for Sphincteric Incontinence in the Male: The Artificial Genitourinary Sphincter and Perineal Sling Procedures. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 10, 2013.

18. Artificial Urinary Sphincter 16 3 components: urethral cuff, pressure regulating balloon, and control pump How it works: The cuff wraps around the urethra, inflates and keeps the urethra closed and urine stays in the bladder Squeezing the control pump deflates the cuff, opens the urethra and allows urine to exit the body Side Effects Urinary Retention Infection Urethral erosion 16. Surgical Procedures for Sphincteric Incontinence in the Male: The Artificial Genitourinary Sphincter and Perineal Sling Procedures. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 10, 2013.

19. Summary Incontinence is a common problem Some treatments are more effective than others depending on your needs and preferences Talk to your partner Talk to your doctor to discuss what treatment option is best for you. You could LIVE LIFE DRY!

20. Questions on Male Urinary Incontinence? ©2014 American Medical Systems, Inc. (“AMS”). The grant of permission to use AMS’ copyrighted materials does not constitute endorsement by AMS of any persons, products, services, or organizations. MC-01326/October 2013