The Evolution of Management of Male Stress Urinary Incontinence

“Introduction: The struggle to treat male stress urinary incontinence (SUI) dates back centuries, with descriptions of male

urinary incontinence (UI) in Egyptian manuscripts as early as 1500 BCE. In this review, we chronicle the history of male SUI

interventions that have educated the modern options available today.“

 

“Results: French surgeon Ambroise Paré is credited with developing the first portable urinals in 1564, which was quickly

followed by Hildanus developing the condom catheter and penile clamp in the 1600s. The first documented compression

device was developed by Lorenz Heister in 1747. Two hundred years later, Frederic Foley created a urinary sphincter and

in 1973, F. Brantley Scott created the first multi-component artificial urinary sphincter (AUS). In the 1960s and 1970s, mesh

implants were fraught with complications, including urethral erosion, fistulas, and pain. More recently, the transobturator male

sling, which came to market during the 2000s, has become an option for select men.”

Credit to Doersch et. al.

This history is not recognized in the medical literature until the last century and especially post World War II when spinal cord injury and many traumatic injuries added to the growing list of surgical causes of incontinence. We will not attempt to give an exhaustive history of this important part of urology but will highlight some contributions leading up to the development of the modern PaceyCuff technology of today.

Early Strategies and the Invention of the Incontinence Clamp

1740 Lorenz Heister published a book Institutions Chirurgiae and popularized the first clamp invented by Hildanus resulting in some improvement in treatment in that era. The venerable Cunningham Clamp was invented by JH Cunningham in 1910.

Early strategies included the urine collecting bag shown here which was a latex precursor of the Condom Catheter products and leg collecting bags of today. The pediatric adjustable clamp shown here is interesting because the design has some of the features of the PaceyCuff such as adjustability, a Cuff concept, and some lateral space for the circulation on each side of the device. While we do not know how well these devices served patients it is likely that they provided some control at a time when little else was available. There is a significant "do it yourself" history that used wires, elastics, and any number of clips and clamps.

Poor Treatment of Incontinence Sufferers and Followed Enlightenment

Prior to 1950 incontinence sufferers were treated like poorly motivated individuals and a culture of “Blame the victim” was prevalent that was probably due to the professions inability to help very effectively.  In the 1860s Trousseau wrote that Children should be punished, adults had weak Character, and that the elderly should be shamed for their weakness.

Enlightenment started to be apparent in the early post WWII era when great strides were made in Health care thinking

Pelvic Floor Enhancement and Therapy

Pelvic floor enhancement strategies started to emerge in 1951 when Arnold Kegel described pelvic floor exercises designed to strengthen the pelvic muscles after surgery or injury.  Alice Morrissey in 1951, a nurse, developed a strategy for nursing rehabilitation of incontinence sufferers as well as approaches for many other difficult problems like bowel rehabilitation.

Measurement systems began to develop to record Bladder function in a field that became known as Urodynamics. The Bladder scan innovation was introduced some years later by Gerald McMorrow and Diagnostic Ultrasound from Seattle allowing bedside measurement of bladder volumes and images so that nursing could make rapid treatment decisions and investigate patient pain and discomfort. Prostate Cancer surgery grew very rapidly as well greatly improving care.

More history of incontinence treatment will follow in subsequent posts so keep tuned and learn with Pacey MedTech as we continue to innovate new solutions.

The recent addition of the PaceyCuff partner, the PaceyCuff Jock is very important because use of the 2 products together cut user costs significantly. Washable “Green” absorbent pads are reused to minimize the vast number of continence pads going to landfill sites.

 

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References

International Journal of Urologic History   January 2022 Vol. 1, No2.

Karen M Doersch1, Michael Witthaus2, Gareth Warren1, Ronald Rabinowitz1, Divya Ajay1, *

From the (1) Department of Urology, University of Rochester Medical Center, Rochester, New York and (2) Department of Urology, University of California, San Diego School of Medicine, San Diego, California