Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

Abstract

Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

Keywords: Urinary incontinence; post-prostatectomy; surgical device; technology.

Figure 1

Various male slings (MS) and artificial urinary sphincter (AUS) devices. (A) Argus sling; (B) Remeex sling; (C) Advance sling; (D) Virtue sling; (E) ATOMS sling; (F) AMS 800; (G) FlowSecure sphincter; (H) Zephyr ZSI 375; (I) Pro-ACT device; (J) Periurethral constrictor device.