At this year’s AUA, participants from around the world were able to engage in discussion and hands-on training regarding the global options for male stress urinary incontinence (Figure 1). The course, led by codirectors Drs Bob Yang and Susan MacDonald, featured 6 products used to treat male stress urinary incontinence. Urethral bulking was represented by dextranomer/hyaluronic acid and polyacrylamide hydrogel, the urethral slings featured included the AdVance sling and the ATOMS sling, and the artificial urinary sphincters (AUSs) included the ZSI 375 and the AMS 800. The introductory portion of the course featured lectures on the product design, components, durability, success rates, and complications. Patient selection for each category (bulking vs sling vs sphincter) was highlighted as this is crucial to the success of these operations. The adjustable nature of the ATOMS sling and ZSI 375 sphincter were contrasted to their fixed counterparts available in the US, and how/when to add fluid to the systems postoperatively was presented. After a rousing question-and-answer portion, participants were able to jump right in!

Figure 2. Steve Foley instructs a course participant.

Figure 3. Pelvic anatomy model constructed from meat products, courtesy of Boston Scientific.

Particularly unique were the available models, hands-on simulation, and the individual tips/tricks provided by faculty instruction. Participants were able to inject dextranomer/hyaluronic acid and polyacrylamide hydrogel into pig urethras using cystoscopes and injection needles, giving them a real feel of the resistance during injection as well as the proper mucosal plane to obtain a pillow and thus outlet resistance. Bony pelvis models with simulated obturator membranes and corpora spongiosum were used to allow participants to pass the trocars for the male sling (Figure 2). Learners could then see how to properly situate and anchor each sling. Finally, for the AUS portion, Boston Scientific kindly provided models created out of the bony pelvis with animal meat that simulated skin, penis, testicles, corpora spongiosum, and corpora cavernosum, giving a nearly true-to-life representation of perineal incontinence surgery (Figure 3). Participants were able to practice measuring the cuff size for an AUS, pass the tubing to a suprapubic incision, seat the pressure-regulating balloon and scrotal pump, and connect all aspects of the device. Additionally, for the ZSI 375 sphincter and ATOMS sling, instructors demonstrated how to add fluid to the systems and discussed judgment of how much/when to add fluid. Each participant was able to perform the surgery at all 6 skills stations in small groups with guidance from faculty instructors, and time was given for questions at the end. This is the perfect course to expand your horizons globally, brush up on a previous skill set, pick up a variation on a theme, or increase your surgical volume by building confidence in a myriad of techniques. Thank you to all who helped make this learning experience possible.