• Presented by Dr. Mark P. Posner
• Louisiana Occupational Health Conference
• August 4, 2012
• Baton Rouge, La.

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
– Combination of the above

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

• 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

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

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