1 THE 3 I’s of UROLOGY Presented by Dr. Mark P. Posner Louisiana Occupational Health Conference August 4, 2012 Baton Rouge, La. 1

2 INCONTINENCE 2

“The objective demonstration of involuntary loss of urine consequent to bladder and/or sphincter dysfunction.” What is urinary incontinence?

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 –Combination of the above Hunskaar et al. One hundred and fifty men with urinary incontinence. Scand J Prim Health Care 1993; 11:

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 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

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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 when deflated

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