Alan Wein: Hi there, I'm Alan Wein from UroToday, and it's my great pleasure today to be interviewing Craig Comiter, who's like the guru of male urinary incontinence, which basically boils down, except for overactive bladder, to stress urinary incontinence. Yeah. I remember when I used to do a lot of radical prostatectomy, not robotic, but open, and patients were continent afterwards in 10, 15 years they would say, "Doc, I've begun to leak a little bit." And I always attributed that to age-related degeneration of the sphincter. And I think that that does happen as you get older. Unfortunately, everything sags and I guess the sphincter is no exception. So last question, what's your favorite as far as a sling and a sphincter?

Craig Comiter: So again, I decide based on the objective degree of incontinence.

Alan Wein: But I mean, once you've decided a sling, which sling do you prefer or sphincter? Which sphincter do you prefer?

Craig Comiter: So for real old-fashioned mild incontinence, I prefer the transobturator AdVance sling because it's quick, it's easy. The complication rate is extremely low and retention is extremely rare. If it's more moderate, say 200 grams a day, I will push for the quadratic sling because the prepubic component adds that slight boost of continence. So I'll do a quadratic sling for 200 grams of leakage and a transobturator sling for less than 200 grams of leakage. Once they get well over 200 grams of leakage, what we would all call severe incontinence, I do recommend the artificial sphincter.

Interestingly, about two-thirds of the men that I recommend the artificial sphincter to still want the sling. So they've made their decision before they ever saw me. Perhaps they seek me out for the sling and I just reassure them, "If the sling is not adequate for you, we can put the artificial sphincter in." It's downstream from the sling, so in some ways the sling acts almost like a double cuff, so I tell them, "It's a low-risk procedure. 75% success rate is pretty darn good, but it means one out of four of you guys are going to have an artificial sphincter after, and that's okay." As far as the brand of artificial sphincter, we only have one, the Boston Scientific model. But I think the electronic artificial sphincter will be a no-brainer replacement simply because we won't lose balloon elasticity because it's a metal can that holds the fluid, and that should markedly decrease revision rates.

Alan Wein: Great. Anything else you want to add at all?

Craig Comiter: Just how appreciative I am that you invited me to do this.

Alan Wein: Listen, thank you. I think that's going to prove very illuminating for the audience, so take care, my friend, and thank you so much again.

Craig Comiter: Thank you.