新しい尿失禁防止具(Penoring仮称)の試み

Abstract

A new type of penile clamp (Penoring) was applied to 14 male urinary incontinence patients including 5 post-prostatectomy incontinence and 9 neurogenic bladder dysfunction. The device is made from dimethylpolysiloxane, which is ring-shaped and is placed along the penile shaft from the glans penis. A small balloon is attached to the inner surface of the ring. The balloon can be inflated or deflated through a silicone tube connected to a small pinch-pump. It selectively compresses the urethra of the patient when inflated to prevent urinary incontinence. The clamp was evaluated not only with respect to changes of complaints but also through x-ray examinations and/or urethral pressure profilometry (UPP) before and after application of the Penoring. Urinary incontinence was successfully prevented in II of 14 patients. Maximum urethral pressure averaged 63cmH2O without the Penoring and increased to more than 129cm H2O with the device according to UPP measurement. Functional profile length of average 5.4 cm increased to 11.8 cm after the application of the device. Urethrogram or voiding cysto-urethrogram aslo showed its effectiveness in preventing urinary incontinence. The Penoring was found to have various advantages. It is light, non-irritating to the foreskin and makes possible to change the clamp effect by regulating the pressure of the ba lloon according to the degree of the incontinence. It proved to be applicable even in small boys. However, it was obliged to discontinue its use in 3 patients and several other patients were not satisfied enough with the device so they used the Penoring in conjunction with previous methods for controlling urinary incontinence. The main cause of these problems was thought to be that the size of silicone ring in the Penoring did not exactly match the penile shaft of each patients so as to get a complete clamp effect on the urethra. Some redesigning of the device, therefore, is intended in the future.