Dr. Abdullah Ahmad Ghazi (R5) KSMC

 Estimated as:  5-69% of women  1-39% of men.

 Age.  LUTS.  Infection.  Functional and cognitive impairment.  Neurological disorders.  Prostatectomy.

 Sphincter-related  Postoperative Post-prostatectomy for benign disease Post-prostatectomy for prostate cancer Post radiotherapy, brachytherapy, cryosurgery, HIFU for prostate cancer Post cystectomy and neobladder for bladder cancer  Post-traumatic After prostato-membranous disruption and urethral reconstruction Pelvic floor trauma  Unresolved paediatric UI  Exstrophy and incontinent epispadias

 Bladder-related  Refractory UUI (overactive bladder)  Reduced capacity bladder  Fistulae  Urethro-cutaneous  Recto-urethral

 Hx  Ex  Urine analysis  PVR  Voiding diary.  Pad test.  Renal profile.  U.cystoscopy.  Image (U/S, VCUG, IVP).  UDS.

 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.

 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.

 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.

 How long to wait ?  Artificial urinary sphincter (AUS) success rate %.  Male slings 58%.  Bulking agents, early failure 50%.

 Cognitive impairment.  Dexterity restriction.

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 Risk is %, increase with time.  More as adjuvant therapy, or Hx of TURP.  AUS post XRT associated with more complications.

 Perineal compression slings (limited evidence).  Injectable agents (not successful).

 Brachytherapy 0-45%.  Cryotherapy 0-5%.  HIFU  Rx: AUR  Injectable material not successful.

 Cause of incontinence after AUS:  Alteration in bladder function.  Urethral atrophy.  Mechanical malfunction.