Operative Therapy for Stress Urinary Incontinence in Men - From Sling to Artificial Sphincter

Radical prostatectomy is the most common cause of male urinary incontinence. Up to 90% of the patients are incontinent in the early postoperative phase. This rate reduces to 3-23% approximately 12 months after prostatectomy. Male slings and the ProACT (TM)-Ballon system are preferred minimal invasive therapeutic options for mild to moderate incontinence. Mid-term continence rates of 50-80% can be achieved with bone anchored and adjustable slings or the adjustable ProACT (TM)-Ballon system. The results after radiation therapy are significantly poorer. Randomised controlled trials with longer follow-ups are necessary in order to evaluate the effectiveness of these options for continence therapy. Considering the high continence rates of 73-92% in long-term follow-ups, the artificial urinary sphincter (AUS) still remains the gold standard in the therapy for incontinence in men with normal dexterity and mental status. In cases where continence cannot be achieved by implantation of an AUS, a urinary diversion can be taken into consideration.