Surgical treatment of stress incontinence in men

A committee at University of Toronto, was charged with the responsibility of reviewing and evaluating all published data relating to surgical treatment of male urinary incontinence since the previous consultation in 2004.

Researchers concluded that specialist evaluation of the patient is primarily a clinical approach with history, frequency-volume chart, physical examination, and post-void residual urine. At the same time, they consider that other investigations such as radiographic imaging of the lower urinary tract, cystoscopy, and urodynamic studies can provide important information for the clinician.

The study investigation revealed some points:

• For stress incontinence of various etiologies the artificial urinary sphincter (AUS) has the longest record of satisfactory results.
• Consideration must be given to the need for revisions for mechanical breakdown, erosion/infection, and recurrent incontinence, as well as cost.
• Sling procedures are increasingly being reported to have good outcomes for mild to moderate incontinence.
• Injectable agents have not shown durable results but newer technologies such as volume-adjustable balloons have shown favorable early results.
• Incontinence following cystectomy with neobladder and pelvic trauma has been treated most commonly with the AUS.

The committee has also concluded that further research is also needed to elucidate the mechanism of post-prostatectomy incontinence.