Urinary stress incontinence in men: diagnostic workup and modern surgical treatment

Abstract

Radical prostatectomy is the most common cause of urinary stress incontinence in male patients. The exact pathophysiology is not clearly defined but probably due multifactorial. Thorough preoperative diagnostic workup before surgical therapy appears to be crucial for good postoperative results. Various systems are available. The artificial urinary sphincter continues to be considered standard procedure with ahigh success rate, even in patients with more complex situations and severe urinary incontinence. However, there are also relevant complication and revision rates. Modern alternatives include various sling systems. The adjustable sling systems consist of acushion that is placed against the urethral bulb and leads to apermanent increase in urethral resistance, which can be readjusted in different ways depending on the system implanted. The adjustable sling systems also seem to be an alternative in patients with aprior history of radiation therapy. The AdVance XP sling (Boston Scientific, Marlborough, MA, USA) is afixed sling that corrects the postoperative hypermobility of the posterior urethra after radical prostatectomy and, thus, leads to alonger functional urethral length. Good long-term results after AdVance XP implantation are only possible in selected patients.