Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success

Abstract

Purpose Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. Methods A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACT TM system. Patient selection criteria, success rates, and complications were compared between the studies. Results Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0–1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73–93% vs 70–90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Conclusion Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.

Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings

“…This strongly affects the reported number of patients considered continent. Some studies have accepted the use of 1 pad in the continence category (social continence) [23], [24]. If the use of one pad is admitted continence rates rise from 58-83% at six-month follow-up.…”

Post-Prostatectomy Urinary Incontinence

“…A urodynamic test is required if the patient has neurogenic disorders or OAB symptoms, especially to assess detrusor function [51]. However, the use of urodynamics in therapeutic decision-making is still debated.…”

“…Male slings are classified as adjustable and nonadjustable based on whether the tension can be adjusted or not after the procedure according to the patient's continence status [51].…”