Surgery for post-prostatectomy urinary incontinence: Update from the 7th ICI

Objective: To present the recommendations for post-prostatectomy urinary incontinence from the 7th International Consultation on Incontinence (ICI). Methods: This review was based on hand- and electronically-searched literature, abstracts from scientific meetings, and articles from peer-reviewed publications. Results: Bladder diary and pad tests are useful in determining the amount of leaking. Treatment planning may benefit from cystoscopy and/or urodynamics, depending on underlying comorbidities and subtype of LUTS. Men with SUI have a low success rate with injectable bulking agents. The artificial sphincter is the preferred treatment for properly selected men who have moderate to severe stress incontinence after radical prostatectomy as the AUS has the longest record of safety and efficacy. This recommendation relates exclusively to the AMS 800 as newer devices do not have a similar evidence base or experience. Male slings are an acceptable surgical approach with several-year follow-up data supporting their safety and efficacy in men with mild to moderate degrees of PPI, particularly if there is no prior history of radiation. Conclusions: Prospective randomized clinical trials are still needed, even though there are a number of series detailing the results of various surgical procedures for PPUI. Standardized workup and outcome metrics, as well as comprehensive long-term reporting of adverse events, are among the recommendations for future research.