Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts

Abstract

Context: Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still insecurity about its therapeutic management.

Objective: To evaluate current evidence regarding therapy of postprostatectomy incontinence (PPI).

Evidence acquisition: In October 2017, a nonsystematic review of the literature published within the last 2 yr was performed using the PubMed/Medline database. In total, 58 articles were included in the current analysis.

Evidence synthesis: Regarding invasive management of moderate-to-severe PPI, artificial urinary sphincter (AUS) is still the treatment of choice. Recent studies focused on efficacy, but also a plethora of potential predictive features for treatment success has been investigated. Owing to inconsistent results, there still is no consensus about valid risk factors of AUS treatment success to date. There are increasing efficacy data about the use of adjustable slings, and long-term follow-up results are now available for the AdVanceXP male sling. Evidence addressing the use of the quadratic Virtue male sling needs further evaluation. To date, there is no randomized controlled trial investigating the outcome of one specific surgical treatment or comparing the outcome of different surgical treatment options. Limitations include the nonsystematic approach.

Conclusions: Level of evidence addressing the surgical management of PPI is increasing but still unsatisfying.

Patient summary: In this review article, we look at current research regarding surgical management of stress urinary incontinence following radical prostatectomy. Many studies focus on how to predict treatment failure and outcomes after artificial urinary sphincter implantation. In addition, more information on the long-term results after male sling implantation is now available.

Keywords: AMS 800; ATOMS; AdVance; Argus; Artificial urinary sphincter; Male; Male slings; Postprostatectomy incontinence; Urinary stress incontinence; ZSI 375.