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THE 3 I’s of UROLOGY • • • • Presented by Dr. Mark P. Posner Louisiana Occupational Health Conference August 4, 2012 Baton Rouge, La. 1 INCONTINENCE 2 What is urinary incontinence? “The objective demonstration of involuntary loss of urine consequent to bladder and/or sphincter dysfunction.” Types of incontinence • Stress Incontinence – Leakage during physical activity that increases intraabdominal pressure, i.e. lifting, exercising, sneezing, and coughing • Urge Incontinence – Leakage associated with an overwhelming need to urinate Gotta go, gotta go! • Mixed Incontinence What to expect at an office visit • History – Pregnancy, Delivery – Spinal or neurologic disease – History of DM • Physical Exam – Neurologic exam • Urinalysis • Postvoid Residual • Urodynamics, Cystoscopy Treatment options • • • • • Behavioral modification Biofeedback Medications Injectables Surgery Behavioral modification • • • • Decrease fluid intake Void frequently Avoid caffeine, alcohol Avoid activity that increases intraabdominal pressure Pelvic floor rehabilitation • a.k.a. biofeedback • Means of teaching Kegel exercises • Objective way to measuring pelvic floor strength • ? how much better than verbal instruction MEDICATIONS for OAB(URGE INCONTINENCE) • • • • • • • • • Ditropan Detrol Toviaz Vesicare Enablex Sanctura Gelnique Oxytrol BoTox Treatment Options for SUI • Nonsurgical treatments • Pelvic floor muscle training • Bladder training • Prompted voiding Surgical treatments • Open retropubic colposuspension (Burch colposuspension) • Suburethral sling procedure SLING PROCEDURE • Indicated for use in patients with SUI due to urethral hypermobility and/or intrinsic sphincter deficiency (ISD)19 • Synthetic mesh is placed under bladder neck (proximal urethra) or mid-urethra 12 13 IMPOTENCE or ERECTILE DYSFUNCTION? The inability to maintain an erection firm enough to have sexual intercourse How Common Is It? • 1 in 10 men • Over 30 million American men • 90% physical, 10% psychological Physical Causes of ED • Diabetes • Heart Disease • Surgery (Prostate, Bladder, Colon, Rectal) • Medications • Spinal injury • Hormone imbalance Treatment Options • Oral Medications (Viagra®, Levitra®, Cialis®) • Vacuum Erection Devices • Injection Therapy • Urethral Suppositories • Penile Implants Oral Medications Penile Implants Ideal for men who have tried other treatments without success • On the market for over 30 years • 25,000 penile implants per year • Over 300,000 implants to date • High patient and partner satisfaction The Satisfying Solution for You and Your Partner Three – Piece Inflatable Penile Implant Advantages Same advantages as two – piece plus: Acts and feels more like a natural erection Expands the girth of the penis More firm and full than other implants Feels softer and more flaccid The Satisfying Solution for You and Your Partner Three – Piece Inflatable Penile Implant Disadvantages Requires some manual dexterity Possibility of leakage or malfunction Possibility of unintentional erections
