Medical & Surgical Urology
Open Access

Abstract

Surgery for Post-Prostatectomy Incontinence - A Changing Field

Craig V Comiter and Christopher Elliott

The most common cause of male stress urinary incontinence is intrinsic sphincter deficiency secondary to iatrogenic injury during prostate cancer surgery. While conservative management is typically offered during the first 6-12 months, most efficacious therapeutic options are surgical in nature. The most common treatments include periurethral bulking, artificial urinary sphincter, and various male slings. During the last 15 years, innovations in malesling design and technique have resulted in a substantially greater interest in this particular option. With several choices now available to patients, the number of sling surgeries performed each year is steadily increasing. Recent evidence has demonstrated that male slings are most efficacious in men with mild to moderate stress incontinence, no history of pelvic radiation, and without prior artificial sphincter placement. In this population, high efficacy with verylow complication rates can be expected. In men with more severe incontinence, especially following radiotherapy, the artificial urinary sphincter typically offers predictably reliable efficacy, with an acceptably low complication rate. Recent advancements in sling technology may provide improved efficacy even in those with more severe leakage.