Artificial Urinary Sphincters for Moderate Post-Prostatectomy Incontinence: Current Research and Proposed Approach

SIMPLE SUMMARY: Stress urinary incontinence is a common sequela in men after radical prostatectomy for the treatment of prostate cancer. Varying degrees of post-prostatectomy incontinence will present after surgery and surgical treatment may be recommended after one year. The severity of incontinence can range from less than 1 urinary pads per day (PPD) to more than 5 PPD. Treatments for mild incontinence include the male sling while more severe incontinence often requires an artificial urinary sphincter (AUS). Currently, patients with moderate incontinence are treated with either a sling or AUS with variable results. In this paper, we reviewed recent research to demonstrate that AUS should be considered first-line for moderate incontinence. While patients and physicians may be hesitant to proceed with an implantable device, patients achieved better continence rates and overall quality of life when they underwent AUS placement for moderate post-prostatectomy incontinence. ABSTRACT: Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.