IPT

Question 1

What are risk factors for IPT?

Answer 1

Surgery, larger prostate size, increasing patient age

Question 2

What are risk factors for climicturia or sexual arousal incontinence?

Answer 2

Closer to surgery time, prior turp, shorter urethra and penile length

Can occur in surgery or radiation pts

Question 3

What should you counsel patients to do prior to prostatectomy?

Answer 3

PFPT

Question 4

What do you need to counsel patients undergoing TURP or prostatectomy after radiation?

Answer 4

Increased chance for incontinence

Question 5

What’s the earliest you can do IPT surgery after prostatectomy?

Answer 5

6 months. But need to counsel patients undergoing it make take one year on conservative tx

Question 6

Name hx for IPT

Answer 6

Characterize incontinence
Severity
Progression
Which activities
Does it occur at night.
Urgency, strong desire?
Pads?
Past tx

Question 7

What are tx options?

Answer 7

Non-surgical: caths (condom and urethral), penile clamps, pads

Question 8

What should be performed prior to surgery?

Answer 8

Cystoscopy

Question 9

What are risks of AUS?

Answer 9

Erosion, persistent incontinence, infection, pain, mechanical failure

Question 10

What is important for AUS placement?

Answer 10

Must be cognitively there

Question 11

In patients who undergo radiation, which intervention is preferred?

Answer 11

AUS. And even then, continence rates are achieved less than non radiated

Question 12

Are bulking agents recommended?

Answer 12

No

Question 13

What are risk fxs for AUS erosion?

Answer 13

Radiation
Prior urethral surgery
IPP placement
Prior erosion
Possibly cuff size
And technique of placement

Question 14

What are failure rates of AUS?

Answer 14

24% at 5 yrs, 50% at 10 years

Question 15

How long to wait after AUS explant for infection?

Answer 15

3 mths

Question 16

How to manage cuff erosion?

Answer 16

Explant and leave catheter for a few weeks

Question 17

What to do if persistent incontinence post AUS?

Answer 17

Through hp, make sure they are using it right!!
If prb is of concern, do u/s
Cysto to see if bad cuff size

If device is working - get UDS!!

Question 18

In revision, what are some options?

Answer 18

Move cuff to different location
Change prb location
Change cuff size
Tandem cuff

Question 19

Treatment options for climicturia?

Answer 19

Some resolve on own
Empty bladder prior to sex
Use condoms
Orgasm while supine
PFME
Penile tension loop
AUS
Sling
Graft to bottom of bilateral corporatomies of IPP