Waves of Change: National Trends in Surgical Management of Male Stress Incontinence

To determine the national trend in surgical management of male stress urinary incontinence (SUI) in the context of the rate of radical prostatectomy (RP) as reported by a national database. Traditionally the artificial urinary sphincter (AUS) has been the gold standard of surgical management, but the male sling represents a newer and popular alternative. Refinements in prostate surgery may reduce the incidence and degree of subsequent SUI.

A retrospective cross sectional analysis was performed using the National Inpatient Survey (NIS) database, which captures discharge data from inpatient and overnight admissions. Cases were identified by their ICD-9 procedure codes. To identify incontinence procedures we queried codes 58.93 (implantation of AUS), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension). We also queried 60.5 (radical prostatectomy) during the same period for comparison. Data was collected from January 2000 through December 2012. Data was weighted to a national average using NIS guidelines.

32,416 anti-incontinence operations were performed over the study period. These consisted of 20,790 AUS and 11,625 sling procedures. There was a significant downward trend in the total number of incontinence procedures (F(1,11)=6.15, p= 0.03). However, when stratifying the data by procedure type, only AUS placement demonstrated a significant decline (F(1,11)=21.70, p<0.01) while sling procedures significantly increased (F(1,11)=12.95, p<0.01). There was no significant change in the annual incidence of RP.

Inpatient surgery for male SUI is decreasing overall. Placement of the AUS declined significantly while sling placement became more common. Future study will determine the etiology of these trends.

Urology. 2017 Jul 11 [Epub ahead of print]

Susan MacDonald, Marc Colaco, Ryan Terlecki

Department of Urology, Penn State Hershey Medical Center, Hershey, PA 17033. Electronic address: ., Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC 27157.