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Implantable Systems for Stress Urinary Incontinence

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Abstract

Stress urinary incontinence (SUI), the involuntary urine leakage due to failure of the urethral closure mechanism, is a global health challenge with substantial human suffering and socioeconomic costs. Approximately 167 million male and female patients are predicted to suffer from SUI in 2018, worldwide. A wide range of surgical interventions are available for the treatment of SUI. Severe cases, however, usually require the implantation of artificial urinary sphincter devices. This review comparatively presents and analyzes the working principles, as well as the challenges, associated with the current implantable SUI systems in clinical use. These include slings, urethral bulking agents, artificial urinary sphincters, and adjustable continence devices. It further reports on recent research progress and state-of-the-art in the field of SUI implants, including an original approach proposed by the authors with a pressure feedback sensory mechanism. The new emerging field of artificial muscle devices, including electroactive polymers, provides a promising innovative solution for replacing the weakened urethral sphincter in SUI patients.

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Abbreviations

AUS:

Artificial urinary sphincter

BAMS:

Bone anchored male sling

DEA:

Dielectric elastomer actuator

EAP:

Electro-active polymers

ICS:

International Continence Society

ISD:

Intrinsic sphincter deficiency

SMA:

Shape memory alloy

SIS:

Single incision sling

SUI:

Stress urinary incontinence

TOT:

Transobturator tape

TVT:

Tension-free vaginal tape

UBA:

Urethral bulking agent

UI:

Urinary incontinence

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Acknowledgments

The authors greatly acknowledge the financial support of Khalifa University internal research fund (KUIRF Level 1) for this work which is part of the “Bionic Implantable Sphincter for Urological Incontinence” project. We also acknowledge the research collaboration with Professor Lee and her team at KAIST, whose complementary expertise have been invaluable to this project. The authors declare that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE

    Kenana M. Al Adem, Sarah S. Bawazir, Ahsan H. Khandoker, Kinda Khalaf, Tim McGloughlin & Cesare Stefanini

  2. Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA

    Waleed A. Hassen

  3. Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE

    Waleed A. Hassen

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  1. Kenana M. Al Adem
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  2. Sarah S. Bawazir
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  3. Waleed A. Hassen
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  4. Ahsan H. Khandoker
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  5. Kinda Khalaf
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  6. Tim McGloughlin
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  7. Cesare Stefanini
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Correspondence to Cesare Stefanini.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Al Adem, K.M., Bawazir, S.S., Hassen, W.A. et al. Implantable Systems for Stress Urinary Incontinence. Ann Biomed Eng 45, 2717–2732 (2017). https://doi.org/10.1007/s10439-017-1939-9

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  • DOI: https://doi.org/10.1007/s10439-017-1939-9

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