Male Stress Incontinence Research Articles

The electronic artificial urinary sphincter: ongoing innovation of a classic device-a narrative review.

While the modern artificial urinary sphincter (AUS) has benefited from incremental innovation, which has improved both device efficacy and complication rates, the foundational technology in use in Boston Scientific's AMS800 can be traced back to the fundamental hydraulic tenets of the AS721. Research and development in adaptive technology and electronic integration stand to further improve AUS outcomes. The Medline online retrieval system was queried using the MeSH terms "artificial urinary sphincter", "electronic", "complications", "history", and "development" in various combinations. Publications were reviewed if applicable, and their reference lists were used to collect additional articles as needed. Final article inclusion was based on senior author discretion. The AMS800 AUS is the gold standard for male stress incontinence implants. A 2015 consensus conference set out the goals for sphincter device development in the coming decades. A future ideal sphincter would adjust cuff pressure dynamically as well as function with minimal manipulation, or even via electronic control. Multiple new devices are in various states of development. During the next decade, artificial urinary sphincter technology is likely to include multiple Food and Drug Administration (FDA)-approved devices with varying features aimed at satisfying the 2015 consensus conference goal for an "ideal" AUS. The future of stress incontinence therapy lies in both continued innovation for the AUS, as well as advances in regenerative medicine. Electronic and adaptive developments in AUS technology will increase device safety, efficacy, and longevity while improving the user and caregiver experience. For some, regenerative medicine may even make AUS technology obsolete.

Structural health care reality in the surgical treatment of male stress incontinence in Germany

Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is adeficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschlüssel-German procedural classification) codes from hospital quality reports from 2011-2019. From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, ahigh number (≥ 50) of radical prostatectomies/year (RPE/year) is an independent predictor of ahigh-volume centre (≥ 10procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted ahigh number of slings (≥ 10slings/year; -69%; -62.4 ± 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34to 10; p < 0.001). This particularly affected departments that also had alow number of RPE/year (from 9to 0; -100%). The situation of surgical treatment of male stress urinary incontinence in Germany shows aclear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that agap in care has developed, as the decline was not compensated for by other surgical therapies.

A Full Bladder Is Not Needed for the Male Stress Incontinence Grading Scale.

Our objectives were to evaluate the Male Stress Incontinence Grading Scale to stratify male patients with stress urinary incontinence for either artificial urinary sphincter or sling using a standing cough test and determine if an emptier bladder at the time of assessment carries increased risk of treatment failure. Retrospective chart review of male patients undergoing sling and artificial urinary sphincter placement. The standing cough test score and bladder scan results were documented at initial evaluation. Forty patients underwent sling and 43 underwent naïve artificial sphincter placement. Median follow-up was 7.11 months. Thirty-six/forty slings had complete incontinence resolution or reduction to a safety pad vs 40/43 after sphincter (90% vs 93%, P = .62). Four sling patients (10%) had persistence or recurrence of incontinence. Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). Bladder scan mean was 18.5 cc in the sling failure (SD 21.1) and 38.0 cc in the success groups (38.3), with 32% of success patients having bladder scans of 0 cc, and 63% of < 50 cc. Mean for sphincter patients was 45 cc (56.9). Ten patients with scan = 0 and 7 patients with scans < 30 cc demonstrated grade 4 incontinence. Cough test is a noninvasive, reliable tool to assess stress urinary incontinence severity. Our data suggest it is reliable even when bladders are nearly empty and can effectively stratify patients for sling vs artificial urinary sphincter with a high rate of success.

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Management of male stress incontinence following robotic radical prostatectomy: A retrospective analysis of 326 cases at a tertiary hospital in Portugal

Management of male stress incontinence following robotic radical prostatectomy: A retrospective analysis of 326 cases at a tertiary hospital in Portugal

When kegels aren’t enough: A comparison of surgical and non-surgical treatments for male stress incontinence

When kegels aren’t enough: A comparison of surgical and non-surgical treatments for male stress incontinence

Urinary Artificial Sphincter in Male Stress Urinary Incontinence: Where Are We Today? A Narrative Review

Introduction: Urinary incontinence is a prevalent condition, especially in elderly men, with stress urinary incontinence (SUI) being a common cause after radical prostatectomy. The artificial urinary sphincter (AUS), particularly the AMS 800™ device, has been the gold-standard treatment for moderate-severe male SUI for decades. Despite some technical advancements and alternative devices like ZSI-375, Victo, and BR-SL-AS 904 being introduced, there is limited literature comparing their effectiveness to the AMS 800™. Methods: This literature review compares the AMS 800™ to the newer technologies in the management of SUI. We reviewed the current literature on urinary sphincter implant in male stress incontinence, including AMS 800™, ZSI-375, Victo, and BR-SL-AS 904. Findings: The AMS 800™ is a sophisticated system consisting of an inflatable cuff, a pressure-regulating balloon, and a control pump. Studies show continence rates ranging from 61% to 100% with AMS 800™ implants, with low infection rates and significant improvement in patients’ quality of life. The ZSI-375 sphincter is a unique single-piece cuff without an abdominal reservoir, simplifying implantation. Preliminary data show a social continence rate of 73% at six months, with lower complication rates than the AMS 800™. The VICTO® device offers adjustable pressure and a stress relief mechanism, providing conditional occlusion of the urethra. Early studies report a satisfaction rate of up to 94.2% and a complication rate of 17.6%. BR-SL-AS 904 is a newly proposed urinary sphincter, but due to the limited number of cases and a single study, its efficacy and complication rates remain uncertain. Conclusions: Overall, AMS 800™ remains the gold-standard treatment for SUI after radical prostatectomy. Alternative devices like ZSI-375 and VICTO® show promising results, but longer studies and more data are needed to establish their effectiveness and safety compared with the AMS 800™. Further research and ongoing monitoring are essential to address mechanical issues associated with AUS implants.

Application of the decisional regret scale (DRS) in men undergoing anti-incontinence procedures for stress urinary incontinence.

Decisional regret (DR) has previously been applied to other urologic issues (hypospadias, prostate cancer). The present study seeks to evaluate certain patient factors that directly correlate to high DR scores in anti-incontinence procedures. Medical records for 119 patients undergoing anti-incontinence procedures between 2009 and 2020 were retrospectively reviewed. Forty-one patients were accessible for telephone follow-up and provided a Decisional Regret Scale (DRS) questionnaire. If patients had both a sling and an artificial urinary sphincter (AUS) placed, questionnaires were administered for each. DRS score was quantified in accordance with prior literature, with scores ranging 0-100. We subdivided patients based on demographics and surgical data, correlating this with DRS score. In 41 patients, 46 procedures (13 slings, 33 AUS) were performed. Thirty-nine (95.1%) men underwent robotic-assisted laparoscopic prostatectomy, and 11 (26.8%) men reported prior pelvic radiation. Post-procedural continence, irrespective of procedure, yielded an average 2±1.56 pads per day (PPD). Mean DRS score across the cohort was 29.78. DRS score was subdivided into mild, moderate, and severe, with majority noting "none to mild" regret (63%), 15.2% reporting moderate and 21.7% severe. Predictors of higher regret included history of radiation (P=0.056), choice of anti-incontinence procedure (P=0.011), and need for surgical revision (P=0.00042). DR was unrelated to race, complete continence, and time to follow-up. DRS has recently been applied to anti-incontinence procedures for male stress incontinence; our study highlights novel findings not previously assessed. Majority of men had minimal regret with a subset that had significant regret-history of radiation, multiple revisions/explant, and those who elected for sling upfront. These results highlight the importance of patient selection and pre-operative counselling.

Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study.

(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher's exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.

Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success.

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. 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. 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. 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.

(548) NIH Funding Trends for Men's and Women's Urologic Conditions

Abstract Introduction Existing literature reports a general trend of increasing National Institutes of Health (NIH) funding for surgeon-scientists in America and shows that urology has not benefited from this trend. NIH funding for urologists continues to lag behind that of our peers in other surgical specialties. Between 2010-2019 urology departments received the second-lowest amount of NIH funding of all surgical specialties, only above plastic surgery. The literature also shows that NIH awards significantly less money to male cancer research (i.e., prostate cancer) than female cancer research (i.e., breast cancer). We sought to explore further gender-specific grant variation within NIH urologic funding by exploring dollars awarded to benign gender-specific non-cancer topics of urologic research. We hypothesized that an NIH funding disparity would exist between men’s health urologic research and research devoted to women’s health urologic issues. Objective To explore NIH funding trends for men's and women's urologic health conditions via the NIH Reporter database Methods We used the publicly available NIH Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER) to perform our data collection. NIH RePORTER is an online search tool of the repository of NIH-funded research projects and is linked to publications, patents and clinical trials resulting from NIH funding. Data was queried for a ten-year period between 2012-2021. We used uniform search parameters including “Department Type: urology” to filter for publications from departments of urology, “Funding Mechanism: research project grant” to eliminate R&amp;D, and “Award Type: new” to capture only first-time awards in our search period. All authors were included in our search, which encompassed both trainees and non-trainees independent of Activity Code. We selected four women’s urological health issues and four men’s urological health issues to guide a keyword search. Our women’s urological health issues included overactive bladder, incontinence, and pelvic organ prolapse. In addition, we queried the NIH Spending Category of “Women’s Health”. Our men’s urological health issues include erectile dysfunction, Peyronie's disease, hypogonadism and male stress incontinence. Search terms related to these health conditions were used to query project title, projects terms and project abstracts in the NIH RePORTER. Results Results of our research findings are summarized in Table 1. Of the 12 projects identified that exclusively investigate either a men’s health condition or a women’s health condition, 7 focused on men’s health and 5 on women’s health. NIH spending on women’s health issues exceeded that for men's health conditions by $833,964, a 51% difference, even though fewer projects were identified related to women’s health conditions. Overall, fewer gender-exclusive projects were found than expected. For example, incontinence projects frequently included both male and female-bodied participants. Conclusions NIH appears to devote substantially less funding for investigating benign urologic men’s health issues than benign urologic women’s health issues. Further examination of this funding gap is warranted, and if confirmed it would be prudent to improve NIH urologic funding in general and men’s health research funding specifically. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

(445) A Full Bladder Is Not Needed To Grade Male Stress Incontinence For Prosthesis Patient Selection

Abstract Introduction Stress urinary incontinence (SUI) resulting from prostate surgery can have devastating consequences in men’s quality of life. Patient selection is crucial for successful treatment of SUI with urethral sling or artificial urinary sphincter (AUS). The ideal SUI evaluation tool for determining severity and guiding surgical treatment remains unknown. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide a simple, non-invasive assessment of post-prostatectomy SUI severity, and can facilitate procedure selection. However, uncertainty remains as to whether MSIGS underestimates SUI severity if performed with insufficiently full bladder, increasing the risk of treatment failure. Objective We present our sling and AUS outcomes using the MSIGS for selection. We assessed bladder fullness with random bladder scans (BS) at the time of evaluation to determine if emptier bladder carries increased risk of failure. Methods We conducted a retrospective chart review of male patients undergoing sling and AUS placement. MSIGS and BS were documented at initial evaluation. Additional collected data included age, pads per day (PPD) pre- and post-surgery, post-operative MSIGS, and need for revision or conversion. Success and failure groups were defined as the post-operative use of ≤1 PPD or &amp;gt;1 PPD, respectively. Descriptive and comparative statistics were performed using SAS software. Results From April 2017 to September 2021, 40 male patients underwent sling and 43 naïve AUS placement. Average age was 71.9 for slings and 70.3 for AUS. 80/83 had prior prostatic surgery. Average follow up was 12.5 months. 34/40 slings had complete SUI resolution or reduction of pad use to no more than one PPD vs 40/43 of AUS (85 vs 93%, p=0.4). 4 sling patients (10%) had persistence or recurrence of SUI, of whichone patient underwent AUS placement. MSIGS scores were similar between sling success (83% patients grade 0, 3% grade 1, 14% grade 2) and failure groups (67% grade 0, 33% grade 1). 73% of AUS patient mostly had MSIGS scores 3 or 4. BS was available for 35 sling and 25 AUS patients. Average was 18.5cc in the sling failure group (range 17-161) and 38cc in the sling success, (17-161), with 32% of success patients having a BS of 0cc, and 80% of &amp;lt;60cc. Average BS for AUS patients was 45cc (14-224). 10 patients with BS 0 and 7 patients with BS&amp;lt;30cc demonstrated MSIGS 4 on exam. Conclusions MSIGS is a non-invasive, reliable test to assess SUI severity. Our preliminary data suggests that a full bladder at time of assessment is not necessary to accurately select patients for male sling vs AUS, with high rate of success and patient satisfaction. Disclosure No

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery.

(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.

Complications associated with artificial urinary sphincter in the treatment of male stress incontinence

Complications associated with artificial urinary sphincter in the treatment of male stress incontinence

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review.

Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics. As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

A narrative review of the role of the Male Stress Incontinence Grading Scale in the surgical management of male stress urinary incontinence.

Surgical treatment for male stress urinary incontinence (SUI) includes transobturator slings and artificial urinary sphincters (AUSs). Historically, 24-hour pad weights have been used to objectively grade the severity of male SUI and guide management decisions. In 2016, the Male Stress Incontinence Grading Scale (MSIGS) was developed as a scoring system for the standing cough test (SCT). This test can be performed at the time of initial consultation and is non-invasive, with significantly less burden to the patient compared to historical measures of male SUI. A review of the reconstructive literature was conducted using PubMed and Google Scholar, reviewing articles that discuss the development of MSIGS, its correlation with objective measures of male SUI, and its use in guiding the choice of anti-incontinence surgical management. MSIGS has been shown to have a strong positive correlation with the 24-hour pad weight test and the subjective patient-reported pads per day (PPD). An MSIGS of 3 or 4 is used to recommend a patient for AUS placement and a score of 1 or 2 for male sling placement. Patient reported satisfaction rates were 95% for AUS and 96.5% for sling. Further, over 91% of men in the study reported they would recommend their selected procedure to other men with a similar condition. The MSIGS is a non-invasive, efficient, and cost-effective way to evaluate men with SUI. The in-office SCT can be quickly and easily adopted into any clinical practice and provides immediate objective information that can be used to better counsel patients on anti-incontinence surgery selection.

Quality of Information for Post-Prostatectomy Incontinence Treatments on YouTube

ObjectiveTo assess the quality of information on YouTube regarding post-prostatectomy incontinence treatments. The 2019 American Urological Association(AUA)/(SUFU) Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines recommend the placement of a male sling or artificial urinary sphincter. Patient education is essential for appropriate expectations and patient satisfaction. MethodsThe top 100 most relevant (default setting) YouTube videos searched with terms “post-prostatectomy incontinence” and “male stress incontinence” were assessed using the validated DISCERN instrument, Patient Education Materials Assessment Tool for Audiovisual Materials, and a misinformation Likert Scale. Videos with poor video/audio quality, duplicates, and non-English videos were excluded. Four independent raters were randomly assigned such that each video had 2 raters. Data was analyzed using multivariate linear regression, and inter-rater reliability was measured using Cohen's kappa. ResultsThe median DISCERN score was 2.5 with 71% of videos scoring <=3. The median PEMAT Actionability and Understandability scores were 64.6 (range 0-100) and 79.9 (range 52-100), respectively. The median misinformation Likert score was 1 range (1-4). Less than half of the videos discussed realistic treatment outcomes or the risks (39% and 24%, respectively). PEMAT Actionability and risk discussion significantly predicted average DISCERN score (p < .001). There were no significant disagreements between raters. ConclusionOur study shows most videos on post-prostatectomy incontinence had moderate to low quality information and were published by medical professionals. The majority did not sufficiently discuss realistic outcomes and risks, which are hallmarks of informed decision making. This provides an opportunity for the urologic community to create educational materials that adequately supplement shared-decision making for patients treated for post-prostatectomy incontinence.

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture.

(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher’s exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1–3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2–18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09–1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19–1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08–110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15–2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17–2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.

Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress Incontinence.

(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision aid to predict success. (2) Methods: We reviewed consecutive men treated with first-time ATOMS for post-prostatectomy incontinence from 2014 to 2021 at our institution. Patient demographics, reported pads per day (PPD), 24-h pad-test and Standing Cough Test (SCT), results’ grades 1–4, according to Male Stress Incontinence Grading Scale (MSIGS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were assessed. Treatment success was defined as no pads or a single PPD with ≤20-mL 24-h pad-test. Logistic regression was performed using a stepwise model (entry 0.15 and stay criterium 0.1) to evaluate independent variables’ determinant of dryness. Receiver-operating characteristic (ROC) curves for predictive variables were evaluated and their area under curve (AUC) was compared. A nomogram was generated and internally validated to predict probability of treatment success. (3) Results: Overall, 149 men (median age 70 years, IQR 7) were evaluated with a median follow-up of 45 months (IQR 26). Twelve patients (8%) had previous devices for incontinence, and 21 (14.1%) had pelvic radiation. Thirty-five men (23.5%) did not achieve continence after ATOMS adjustment (use of no or one security PPD with ≤20-mL 24-h pad-test). In univariate analysis, Charlson comorbidity index (p = 0.0412), previous urethroplasty (p = 0.0187), baseline PPD (p < 0.0001), 24-h pad-test (p < 0.0001), MSIGS (p < 0.0001), and ICIQ-SF questionnaire score (p < 0.0001) predicted ATOMS failure. In a multivariable model, 24-h pad-test (p = 0.0031), MSIGS (p = 0.0244), and radiotherapy (p = 0.0216) were independent variables, with AUC 0.8221. The association of MSIGS and 24-h pad-test was the superior combination (AUC 0.8236). A nomogram to predict the probability of ATOMS failure using the independent variables identified was proposed. (4) Conclusions: Several variables were identified as predictive of success for ATOMS using clinical history, physical examination (MSIGS), and factors that evaluate urine loss severity (PPD, 24-h pad-test, and ICIQ-SF questionnaire). MSIGS adds prognostic value to 24-h pad-test in assessing success of ATOMS device to treat post-prostatectomy incontinence. A nomogram was proposed to calculate the risk of ATOMS failure, which could be of interest to personalize the decision to use this device or not in the individual patient.

Standing cough test stratification of moderate male stress urinary incontinence.

ABSTRACTPurpose:Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings.Materials and Methods:We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure.Results:Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01).Conclusions:Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.