Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence.

The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan.

Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis.

Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.

Neurourology and urodynamics. 2018 Oct 23 [Epub ahead of print]

Marcio A Averbeck, Christopher Woodhouse, Craig Comiter, Homero Bruschini, Thomas Hanus, Sender Herschorn, Howard B Goldman

Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil., Adolescent Urology, University College London, London, UK., Stanford Medical School, Stanford, California., Department of Urology, University of Sao Paulo, Rua Barata Ribeiro, Brazil., 1st Faculty of Medicine, Charles University, Prague Prague, CZ., Sunnybrook and Womens Health Sciences Centre, Toronto, ON, Canada., The Cleveland Clinic Foundation, Glickman Urological Institute, Cleveland, Ohio.

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