Optimization of surgical treatment selection for male stress urinary incontinence

Asadulaev M.M., Korolev D.O., Enikeev M.E., Rapoport L.M.

Institute of Urology and Reproductive Health, Sechenov University (First Moscow State Medical University), Moscow, Russia

Introduction. Male stress urinary incontinence (SUI) following prostate surgery significantly impairs quality of life. The main surgical treatment options for SUI are male sling (MS) implantation and artificial urinary sphincter (AUS) implantation. The optimal choice of procedure depends on the severity of incontinence. The 24-hour pad test and pad count do not reliably reflect the functional status of the external urethral sphincter (EUS). The Male Stress Incontinence Grading Scale (MSIGS) has been proposed to improve patient stratification.
Objective. To evaluate the effectiveness of preoperative assessment of SUI severity based on a combination of MSIGS and the 24-hour pad test in guiding surgical decision-making in men with post-prostatectomy SUI.
Materials and Methods. From 2016 to 2022, SUI severity in our clinic was determined using only the 24-hour pad test. From 2022 to 2025, the MSIGS was incorporated into preoperative evaluation. Patients with urine loss ≤200 g/day and MSIGS ≤2 underwent sling implantation, whereas those with urine loss >200 g/day and MSIGS ≥3 received AUS implantation.
Results. Between 2016 and 2025, a total of 39 patients underwent surgery: 13 with slings and 26 with AUS. A history of pelvic radiotherapy (RT) was present in 15.4% (2/13) of sling patients and 30.8% (8/26) of AUS patients. After the introduction of combined assessment (pad test + MSIGS), the proportion of AUS implantations increased from 27% (n=3) to 82% (n=23) (OR=12.27; 95% CI 2.53–50.45; p=0.002). Furthermore, sling efficacy improved from 25% to 80% when patient selection was based on the combined approach (OR=12.00; 95% CI 0.67–165.6; p=0.103). Importantly, the higher rate of AUS implantation was not associated with reduced efficacy (p>0.05).
Conclusion. The choice of surgical treatment for SUI depends on incontinence severity and prior RT. Male sling implantation is effective in mild cases but its efficacy is markedly reduced in severe SUI and in patients with prior RT. The AUS remains the gold standard for severe SUI. The combination of MSIGS and the 24-hour pad test improves diagnostic accuracy and optimises implant selection, which is particularly valuable in patients with moderate SUI.

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About the Authors

Corresponding author: M.M. Asadulaev – PhD candidate at the Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia; e-mail: asadulaev007@mail.ru

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