Research and Reports in Urology (Jun 2023)
Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success
Abstract
Wesley J Smith, Maia E VanDyke, Nikit Venishetty, Brian T Langford, Bryce P Franzen, Allen F Morey Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Allen F Morey, Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA, Tel +214-648-0202, Fax +214-648-8786, Email [email protected]: 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 ProACTTM 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.Keywords: AdVance sling, AdVance XP sling, artificial urinary sphincter, male stress incontinence, male urethral sling, ProACT, REMEEX sling, Virtue sling
