Abstract
Introduction and Objective. Iatrogenic male stress urinary incontinence (SUI) affects a percentage of men undergoing urologic procedures with a significant impact on quality of life. The treatment of male SUI has evolved significantly with multiple current options for treatment available. The current paper discusses preoperative evaluation of male SUI, available surgical options with reported outcomes, and postoperative complication management. Methods. A pubMed review of available literature was performed and summarized on articles reporting outcomes of placement of the artificial urinary sphincter (AUS) or male slings including the bone anchored sling (BAS), retrourethral transobturator sling (RTS), adjustable retropubic sling (ARS), and quadratic sling. Results. Reported rates of success (variably defined) for BAS, RTS, ARS, and AUS are 36–67%, 9–79%, 13–100%, and 59–91% respectively. Complications reported include infection, erosion, retention, explantation, and transient pain. Male slings are more commonly performed in cases of low-to-moderate SUI with decreasing success with higher degrees of preoperative incontinence. Conclusions. An increasing number of options continue to be developed for the management of male SUI. While the AUS remains the gold-standard therapy for SUI, male sling placement is a proven viable alternative therapy for low-to-moderate SUI.
Highlights
Introduction and ObjectiveIatrogenic male stress urinary incontinence (SUI) affects a percentage of men undergoing urologic procedures with a significant impact on quality of life
Any surgical or radiotherapeutic manipulation of the external urinary sphincter may result in SUI, radical prostatectomy (RP), transurethral resection of the prostate (TURP), and radiation therapy are most commonly associated with RP accounting for the majority of iatrogenic etiologies
As the bone anchored sling (BAS) has been available and utilized for a longer period of time than other slings, more studies are currently available for review with longer mean/median follow up periods
Summary
Urinary incontinence is estimated to affect 12–17% of US males, with increasing prevalence associated with aging [1, 2]. Any surgical or radiotherapeutic manipulation of the external urinary sphincter may result in SUI, radical prostatectomy (RP), transurethral resection of the prostate (TURP), and radiation therapy are most commonly associated with RP accounting for the majority of iatrogenic etiologies. External beam radiation therapy and TURP are less commonly associated with SUI, with reported outcomes ranging from 1 to 16% and 1 to 3%, respectively [10,11,12]. With an increasing number of options available for the treatment of male SUI, it is important for treating clinicians to be aware of available therapeutic options, comparative outcomes, and associated complications. The current paper is outlined to review the clinical evaluation of males presenting with SUI, discuss the male sling and AUS as treatment options, review reported outcomes on therapies, briefly discuss management of common postoperative complications, and highlight potential future perspectives
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