Evaluation and Treatment of Persistent Stress Urinary Incontinence after Male Anti-Incontinence Procedure – AUS or Sling

Abstract

The two most common anti-incontinence procedures performed for postprostatectomy incontinence (PPI) are placements of the artificial urinary sphincter (AUS) and male sling. While both procedures offer high success rates, 10-30 % of patients after AUS and 20-45 % of patients after male sling require evaluation for persistent PPI. The goals of evaluation for persistent PPI should be to verify the diagnosis of stress urinary incontinence (SUI) and to assess for concurrent bladder dysfunction. If the initial procedure was an AUS, and recurrent intrinsic sphincter deficiency is diagnosed, it is vital to distinguish among mechanical failure, urethral atrophy and erosion. If a repeat sling is considered, it is necessary to verify the degree of intrinsic sphincter deficiency (ISD) and assess for persistent or recurrent proximal urethral mobility. Because of diminished urethral compliance that results from prior AUS or male sling surgery, implantation of an AUS remains the treatment of choice for persistent SUI, as it is the most reliable method of providing the circumferential urethral compression necessary for adequate coaptation even in the setting of urethral fibrosis.