Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From the AUA Quality Registry

Abstract

Introduction:We examined contemporary patterns in treatment of male stress urinary incontinence and identified predictors of undergoing specific surgical procedures.Methods: Utilizing the AUA Quality Registry, we identified men with stress urinary incontinence utilizing International Classification of Disease codes and related procedures for stress urinary incontinence performed from 2014 to 2020 utilizing Current Procedural Terminology codes. Characteristics of the patient, surgeon, and practice were included in a multivariate analysis of predictors of management type.Results: We identified 139,034 men with stress urinary incontinence in the AUA Quality Registry, of whom only 3.2% underwent surgical intervention during the study period. Artificial urinary sphincter was the most common procedure with 4,287/7,706 (56%) performed, followed by urethral sling with 2,368/7,706 (31%), and lastly urethral bulking with 1,040/7,706 (13%). There was no significant change by year in volume of each procedure performed during the study period. A large proportion of urethral bulking was performed by a disproportionately small number of practices; 5 high-volume practices performed 54% of the total urethral bulking over the study period. Open surgical procedure was more likely in patients with prior radical prostatectomy, urethroplasty, or care at an academic enter. Urethral bulking was more likely in patients with a history of bladder cancer or care by a surgeon of increasing age or female gender.Conclusions: Utilization of artificial urinary sphincter and urethral sling now exceeds utilization of urethral bulking for male stress urinary incontinence, though some practices continue to perform a disproportionate volume of bulking. Using data from the AUA Quality Registry, we can identify areas for quality improvement to facilitate guideline-adherent care.

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

“…Patients unsatisfied with conservative treatment can undergo several procedures to restore continence, such as the placement of an artificial urinary sphincter (AUS), urethral sling, balloon continent devices, or intraurethral injections. 4 Of these options, AUS is the gold standard for postprostatectomy incontinence, with 56% of patients, per a recent query AQUA (AUA Quality Registry), opting for this treatment due to its superior control of symptoms and higher patient satisfaction. 4-6 Urethral sling and intraurethral injections are less popular, with 31% and 13% of patients pursuing these procedures, respectively.…”

“…4 Of these options, AUS is the gold standard for postprostatectomy incontinence, with 56% of patients, per a recent query AQUA (AUA Quality Registry), opting for this treatment due to its superior control of symptoms and higher patient satisfaction. 4-6 Urethral sling and intraurethral injections are less popular, with 31% and 13% of patients pursuing these procedures, respectively. 4…”

“…4-6 Urethral sling and intraurethral injections are less popular, with 31% and 13% of patients pursuing these procedures, respectively. 4…”