Male incontinence surgery in the 21st century: past, present, and future

Abstract

Surgery is the mainstay for treating postprostatectomy stress urinary incontinence. Although the artificial urinary sphincter (AUS) remains a popular treatment option, a decade worth of innovations have expanded the role of male sling surgery. AUS surgery has an approximately 80-85% success rate, regardless of the degree of incontinence. The bone-anchored male sling has a similar success rate in men with mild-to-moderate leakage, but is less efficacious in those with severe incontinence. A transobturator approach has simplified the procedure, but appears best suited for men with milder degrees of incontinence. A new quadratically fixed sling that achieves a broader area of urethral compression by combining a transobturator and suprapubic approach has recently been introduced, with the aim of greater efficacy, while maintaining the low morbidity of sling surgery. The male sling and AUS are equally efficacious for the treatment of mild-to-moderate stress urinary incontinence. The sling appears to have a lower risk of infection, erosion, and urethral atrophy. The AUS remains the most efficacious treatment for severe stress urinary incontinence and for radiated patients. Recent changes in male sling surgery may improve efficacy in men with more severe incontinence.