Treatment options for male stress urinary incontinence

The diagnosis and management of male stress urinary incontinence (SUI) is complex. Various etiologies exist, with radical prostatectomy being the most common cause in men seeking treatment. SUI in this setting is often temporary and resolves within the first postoperative year. Therefore, it is important to understand the natural history of male SUI before initiating treatment. Generally, the initial management of SUI that persists after 12 months consists of conservative measures, such as pelvic floor muscle exercises. Several treatments are available for men whose continence does not improve after pelvic floor muscle exercises. In order of increasing complexity they are urethral bulking agents, male slings, and the artificial urinary sphincter (AUS). With over 30 years of published data suggesting excellent long-term outcomes, the AUS is considered the gold standard treatment of male SUI. Male slings have recently demonstrated efficacy for selected patients and are likely to be used more often in the future as experience with these devices grows.