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Stress Urinary Incontinence (Male)

Male stress urinary incontinence (SUI) is involuntary urine loss with physical exertion, cough, sneeze, or Valsalva. In contemporary reconstructive practice it is overwhelmingly an incontinence-after-prostate-treatment problem: radical prostatectomy, radiation, and outlet surgery can injure the external rhabdosphincter, bladder-neck support, periurethral tissues, and pelvic innervation.[1][2][3] The AUA/GURS/SUFU Incontinence After Prostate Treatment guideline anchors contemporary evaluation, counseling, and procedural selection.[4]

Epidemiology and Etiology​

Post-prostatectomy (the dominant cause)​

After radical prostatectomy, reported SUI prevalence spans a wide range depending on definition, follow-up, and measurement method: 5–60% at 3–6 months, with most resolving by 12 months.[1][2][5] The AUA/GURS/SUFU guideline cites data indicating about 90% continence by 6 months after robotic prostatectomy and 94% by 12 months across studies; a separate robotic cohort followed to 24 months showed only about 1% further improvement between 12 and 24 months, so leakage that persists at 12 months is unlikely to resolve on its own.[4] Persistent incontinence can remain beyond one year after radical prostatectomy.[4][6] In the CEASAR observational cohort at 10 years, moderate or big problems with urinary leakage were reported by 14% after prostatectomy versus 4% after external beam radiation among men with favorable-prognosis cancer, and by 25% after prostatectomy versus 11% after external beam radiation plus androgen deprivation therapy among men with unfavorable-prognosis cancer.[22] The definition drives the number: among 985 evaluable men (of 1,144 consecutive patients) after radical retropubic prostatectomy, actuarial 24-month continence was 83% with no or occasional pad use, 92.3% with 0–1 pad/day for occasional dribbling only, and 93.4% with 0–1 pad/day irrespective of reason.[5]

Risk factors for persistent post-RP SUI:[4][6]

  • Advancing age
  • Larger prostate size
  • Shorter membranous urethral length on preoperative MRI (longer length is protective)
  • Bilateral neurovascular bundle preservation (protective; men were about 26% more likely to be continent at 6 months)[4]
  • Prior or subsequent radiation therapy
  • Higher BMI (associated with short-term leakage; little evidence of an effect at 1 year)
  • Preoperative LUTS and baseline urethral function and surgeon experience (reported in cohorts)

For men considering salvage radiotherapy after radical prostatectomy, AUA/ASTRO/SUO 2024 calls for counseling about risks to urinary control, erectile function and bowel function in the context of risk from recurrent cancer, life expectancy, comorbidities and patient preferences .[21]

The AUA/GURS/SUFU guideline reports similar incontinence rates after open and robotic prostatectomy and identifies bilateral neurovascular bundle preservation as the only maneuver associated with improved 12-month continence in its review.[4] AUA/ASTRO recommends nerve sparing when oncologically appropriate . Its review found favorable but variable continence associations and no randomized comparison of nerve-sparing with non-nerve-sparing prostatectomy.[20]

A Cochrane review of 5 RCTs (571 randomized, 502 completing) found the Retzius-sparing (posterior) robotic approach probably improves continence within a week of catheter removal (RR 1.74, 95% CI 1.41–2.14) and may improve continence at 3 months (RR 1.33, 95% CI 1.06–1.68), with little to no difference by 12 months (RR 1.01, 95% CI 0.97–1.04); it may also increase positive surgical margins (RR 1.95, 95% CI 1.19–3.20).[15]

Other causes​

  • TURP / HoLEP / other BPH surgery. Persistent SUI is uncommon (0–8.4% in the guideline review) but clinically important when apical resection, prior radiation, or sphincter injury compromises the external sphincter.[4]
  • Pelvic trauma. External urethral sphincter damage with pelvic fracture urethral injury
  • Neurogenic. Lesions of the thoracolumbar sympathetic outflow (T11–L2) impair proximal urethral tone; sacral lesions (S2–S4) affect the rhabdosphincter; pelvic plexus destruction, cauda equina compression, and selected spinal cord lesions can similarly unmask sphincteric leakage. For NLUTD patients with SUI and acceptable bladder storage parameters, AUA/SUFU recommends slings and allows an artificial urinary sphincter in selected patients.[7]
  • Post-cystectomy neobladder. Continence depends on an intact external sphincter; SUI here is a distinct problem from reservoir function

Pathophysiology​

Male SUI is fundamentally an intrinsic sphincter deficiency (ISD) problem.[1][2] After prostatectomy, three mechanisms compound:

  1. Direct rhabdosphincter injury during apical dissection
  2. Loss of the proximal continence mechanism. Bladder neck and prostatic urethra no longer contribute
  3. Local denervation from pelvic plexus or pudendal-branch injury

Radiation adds progressive fibrosis of the membranous urethra, stiffens the sphincter, and over years can convert a well-compensated patient into a leaker.

Detrusor overactivity, impaired compliance, and bladder-neck contracture can coexist with sphincter deficiency and produce a mixed incontinence picture. The reconstructive consequence is practical: bladder-only management rarely resolves leakage with a sphincteric driver, and sling or AUS planning should follow treatment of bladder neck contracture or anastomotic stenosis, infection, and urgency-predominant symptoms. In FORESEE's adjusted meta-analysis of two studies (182 men; follow-up at least six months), preoperative detrusor overactivity versus none was associated with failure of overall success after fixed sling implantation (adjusted OR 3.78, 95% CI 1.44–9.98; moderate-certainty prognostic evidence); success meant improvement from baseline or no more than one pad per day, depending on the study.[23] Earlier retrospective cohorts cited by AUA/GURS/SUFU did not find worse AUS outcomes with detrusor overactivity or worse sling or AUS outcomes with small cystometric capacity; high storage pressures or poor compliance should be treated or followed with upper tract surveillance after implantation.[4][6]

Diagnosis and Evaluation​

Initial workup​

  • History. Onset relative to surgery, pad count (pads-per-day, PPD), pad weight, activities that provoke leakage, nocturnal versus daytime distribution, prior radiation, comorbidities, medications
  • Sexual activity. Ask directly about urine loss at orgasm (climacturia) in men with post-prostatectomy incontinence. In a study of 84 men continent and potent at least 1 year after bladder-neck-sparing radical prostatectomy, 24 (28.6%) reported climacturia; in a video-urodynamic sub-study of 7 men with climacturia and 5 controls, functional urethral length was significantly shorter in men with climacturia (P = 0.02) and time to continence recovery was significantly longer (P = 0.05).[18] Climacturia is a distinct symptom from persistent stress leakage during daily activity.[18]
  • Validated instruments. ICIQ-SF, UDI-6, IPSS for mixed LUTS[4]
  • 3-day voiding diary with pad weights
  • Physical exam. Standing cough stress test, perineal sensation, anal tone, DRE (post-RP anatomy)
  • Urinalysis and culture to rule out UTI
  • Post-void residual. Bladder US or catheter
  • Pad test. Pad count correlates reasonably with pad weight, but a formal 1-hour or 24-hour pad test is useful when severity is uncertain[4]

See Assessment Tools & Questionnaires for instrument detail.

Specialized evaluation​

Before an SUI operation, assess urethral integrity and whether further functional testing will change management:[4][6]

  • Urodynamics. Use selectively to clarify the cause of leakage, storage safety or emptying dysfunction and inform counselling; not mandatory for every patient
  • Cystourethroscopy. Perform before SUI surgery to assess urethral and bladder pathology , including contracture, anastomotic stenosis, stricture, lesions or stones; treat symptomatic bladder neck contracture or anastomotic stenosis before sling or AUS. After treating vesicourethral anastomotic stenosis, repeat cystoscopy at least four to six weeks later to document stability.[4]
  • MRI (selected): membranous urethral length if planning anatomic sling

Red flags deserving expedited referral: gross hematuria, new obstructive symptoms, recurrent UTIs, suspected fistula.

Two catheter-related pitfalls can affect the filling-cystometry portion of the study:

  • The filling catheter can itself mask leakage across a tight outlet. In a 60-man protocol study, all men eventually demonstrated urodynamic stress incontinence, but 21 (35%) leaked only after the urethral (transducer) catheter was removed; among men who leaked both with and without the catheter, abdominal leak-point pressure was 86.3 versus 67 cmH₂O, respectively (P = 0.002); men who leaked only after catheter removal had higher leak-point pressures in a separate comparison (P < 0.001).[16] In a man with convincing clinical stress leakage but no leak on catheter-based testing, consider repeating a cough or Valsalva stress test after removing the filling catheter (retaining the rectal pressure line).[16]
  • Severe leakage can itself prevent adequate filling. In a series of 166 post-prostatectomy men undergoing video-urodynamics, 30 (18%) had filling cystometry interrupted by leakage severe enough to prevent reaching cystometric capacity; applying a temporary occlusive penile clamp during filling allowed the study to be completed in each case without altering pressure recording. These men had lower maximum urethral closure pressure, lower volume at strong desire to void, and lower cystometric capacity than the overall post-prostatectomy incontinence population studied.[17] The clamp should not occlude the filling line, and rapid emptying can follow its release.[17]

Severity grading​

Pad count and weight help describe severity, but these practical bands are not validated universal thresholds. The guideline notes that sling studies generally defined severe leakage as more than 500 g/day or more than 5 pads/day. Patient-reported pad use can understate severity: among 299 men reporting mild-to-moderate SUI in a preoperative surgical cohort, 101 (34%) were graded severe by standing cough test; prior SUI surgery and radiation were associated with upgrading.[4][8] A retrospective series of 104 men undergoing anti-incontinence surgery using the Male Stress Incontinence Grading Scale reported a strong correlation between standing cough test grade and 24-hour pad weight (Spearman ρ = 0.68), with mean pad weights of roughly 57 g, 117 g, 223 g, 385 g and 513 g for grades 0 through 4 respectively (reported leakage not seen on exam; delayed drops; early drops without a stream; delayed stream; early, persistent stream).[19]

SeverityPads/day24-h pad weightTypical surgical option
Mild1–2 PPD<100 gObservation, sling or AUS after counselling
Moderate3–4 PPD (2 PPD overlaps the guideline’s mild band)100–500 gSling or AUS (patient preference; prior radiation favors AUS)
Severe≥5 PPD or continuous leak>500 gAUS; male sling should not be routine [4]

For men seeking SUI surgery after primary, adjuvant, or salvage radiotherapy, AUA/GURS/SUFU 2024 recommends AUS over slings or adjustable balloons ; radiotherapy limits sling efficacy and increases AUS erosion and revision risk.[4]

Natural History and Timing of Intervention​

Post-RP SUI follows a predictable recovery curve. The AUA/GURS/SUFU guideline and contemporary series support:[4][5][6]

  • Before and early after surgery: pelvic floor exercises or training may be offered before prostatectomy (the guideline discusses starting 3–4 weeks ahead, while trial start times varied) and should be offered after catheter removal; document the recovery trajectory.[4][9]
  • From 6 months: surgery may be offered for bothersome SUI that is not improving despite conservative treatment .
  • At 1 year: offer surgical treatment for bothersome persistent SUI despite conservative care ; continued observation remains a patient choice.

A minority of men with severe persistent early SUI (e.g., continuous leakage at 6 months with no improvement trajectory) warrant earlier formal evaluation.[4]

Management​

Conservative (first 6–12 months)​

  • Pelvic floor muscle exercises / training (PFME/PFMT). Offer after catheter removal; the guideline evidence indicates earlier return to continence, but similar continence rates at 12 months. The 2023 Cochrane review rates the overall evidence as uncertain, limited by small trials with methodological flaws and non-standardized PFMT protocols[4][9]
  • Lifestyle. Fluid and caffeine management, weight loss, smoking cessation
  • Biofeedback-augmented PFMT. Cochrane found low-certainty, conflicting results (greater subjective cure in one trial, lower objective cure in two), so it has no proven advantage over PFMT alone[9]
  • Electrical stimulation (surface, perineal, or anal) has uncertain benefit after prostate surgery. The 2023 Cochrane review found no stimulation-versus-control trials reporting its prespecified key outcomes; an earlier review of male-incontinence trials found more adverse effects when stimulation was added to PFMT (23/139 versus 2/99), with no significant difference in incontinence at three months (146/239 versus 98/156).[9][10]
  • Penile compression (clamp). A containment option alone or with pads for selected men, including longer-term use. Release it at least every two hours, never wear it overnight, and avoid it when sensation, dexterity or memory is impaired or urgency symptoms are substantial; prolonged pressure can injure skin and urethra.[4]

There is no FDA-approved drug specifically for male SUI. Duloxetine has been used off label with tolerability limitations; bladder medications target coexisting urgency. See the duloxetine hub for its evidence and prescribing status.[6]

Surgical options — overview​

See the Male SUI treatment database for operative options and selection criteria.

Treatment selection integrates severity, radiation history, prior urethral reconstruction or erosion, cognitive and manual ability, and patient preference.[4] In a 2026 meta-analysis of four observational studies (533 men), prior urethroplasty was associated with AUS explantation (RR 2.05, 95% CI 1.08–3.89).[28] For detailed selection criteria and outcomes see the Male SUI treatment database. EAU 2026 advises offering AUS or ProACT implantation only in expert centres .[29] AUA/GURS/SUFU 2024 recommends AUS for persistent or recurrent SUI after a sling .[4]

OptionBest candidateKey consideration
Urethral bulkingMild, patient declining sling/AUSLow efficacy; cure is rare, and repeat treatment may be needed
Male urethral slingMild to moderate, no radiation, intact urethraPassive, no device to operate; best outcomes in low pad-weight patients. EAU 2026 advises counseling that prior transurethral surgery may worsen nonadjustable sling outcomes .[29]
Periurethral balloons (ProACT)Non-radiated men with mild to severe SUI, where available; the FDA label specifies adults with ISD-related SUI for at least 12 months after radical prostatectomy or TURP despite conservative therapy.[4][24]Postoperative titration is the main draw; AUA/GURS/SUFU 2024 gives a Conditional Recommendation (Grade C). FDA contraindications include reduced bladder compliance, detrusor-overactivity incontinence, and PVR >100 mL; evidence and availability vary by region.[4][24]
Artificial urinary sphincter (AUS)Mild through severe; particularly radiation or higher severityMost predictable and reliable option in the guideline; effectiveness can decline over time and reoperation is common for mechanical malfunction, erosion, infection or atrophy. For persistent or recurrent SUI after AUS, AUA/GURS/SUFU 2024 recommends discussing revision after reassessment ; the patient must be able to operate the pump.[4]

Historical autologous fascial slings and Burch-style suspensions have been largely replaced by the options above, though the principle of compression or support under the bulbar urethra persists.[2][11]

Outcomes​

InterventionKey outcomeReference
PFMTThe AUA guideline reports earlier return to continence after prostatectomy but similar 12-month incontinence rates (RR 0.85, 95% CI 0.60–1.22, from its cited older review); the 2023 Cochrane review judged the value of conservative interventions uncertain across heterogeneous trialsAUA/GURS/SUFU 2024; Johnson Cochrane 2023[4][9]
Urethral slingBest outcomes in non-irradiated mild-to-moderate SUI; failure risk rises with high pad weight, prior radiation, and poor urethral mobilitySandhu 2010; Prebay 2023[2][11]
AUSStrong recommendation to discuss AUS for mild to severe post-prostate-treatment SUI; long-term continence and satisfaction are high, but the device likely loses effectiveness over time and reoperation is commonAUA/GURS/SUFU 2024; Sandhu 2010[4][2]
BulkingLow efficacy and rare cure; not a routine substitute for sling or AUSAUA 2024 and older limited comparative evidence[4][12]

Radiation degrades outcomes across every modality; AUS in the radiated patient has higher erosion and revision rates but remains the most effective option.

Complications to Counsel​

AUS-specific: mechanical failure, cuff erosion (higher with radiation), infection or erosion requiring explantation, atrophy requiring downsizing or reposition, and need for patient dexterity to cycle the pump.[4] Deflate the cuff and deactivate the AMS 800 before urethral catheterization or endoscopy.[25] In a retrospective cohort of 194 men with 213 AUS implants, inadvertent catheterization without deactivation preceded 10 of 19 cuff erosions.[26]

Sling-specific: perineal pain, postoperative retention that may require temporary urethral or intermittent catheterization, sling release for persistent obstruction, and mesh-related complications.[4][27]

ProACT-specific: the AUA/GURS/SUFU guideline reports pooled intraoperative urethral or bladder perforation of 5.3% (range 3.4–8%) and mean all-cause explantation of 27% (range 7–55%) across studies, including erosion, infection, balloon migration and balloon failure; counsel about postoperative adjustment, revision and complication burden.[4]

Bulking-specific: migration, repeat injections, limited durability.

Shared: urinary retention, UTI, de novo or persistent overactive bladder symptoms.

Selected evidence​

MASTER · 2021[13]. The 24-month report shows the sling still noninferior, with further surgery in 11% of the sling group versus 2% of the AUS group.[14]

Male urinary incontinence — key study comparisons
Study and populationComparison and resultsUse and limitations
MASTER · 2021

Men with bothersome urodynamic stress incontinence after prostate surgery at 27 UK centres.

Randomized n=380

Source and methods: MASTER · 2021
Source
Abrams P et al. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER) (2021). DOI: 10.1016/j.eururo.2021.01.024
Design
Open-label randomized noninferiority trial
Denominators
190 randomized per group; primary responses from 154 sling and 158 AUS participants.
Follow-up
12 months for this comparison
Transobturator male sling vs artificial urinary sphincter (AUS)

Any patient-reported leakage (strict continence definition) · 12 months

Still incontinent: 134/154 (87.0%) with sling vs 133/158 (84.2%) with AUS. Both groups improved symptom scores.

Noninferiority established against a 15-percentage-point margin (P=.003).

ICIQ-UI symptom score · 12 months

8.7 with sling vs 7.5 with AUS (lower is better).

Adjusted mean difference 1.4; 95% CI 0.2–2.6; statistically different secondary outcomes favoured AUS.

Both can improve symptoms. Select using severity, radiation history, urethral status and ability to operate an AUS.

  • No blinding; incomplete primary questionnaire response; broad noninferiority margin.

See Also​

Podcasts​

Evaluation & Management of Post-Prostatectomy Incontinence
BackTable Urology, Ep. 11 (2021) · Steve Hudak, Aditya Bagrodia
backtable.com

Videos​

Step-by-Step Placement of the Artificial Urinary Sphincter
AUA Core Curriculum (2021)
Complex Male Urinary Incontinence
Drs. Simhan and Selph, GU Recon Lecture Series

References​

1. Koch GE, Kaufman MR. "Male Stress Urinary Incontinence." Urol Clin North Am. 2022;49(3):403-418. doi:10.1016/j.ucl.2022.04.005

2. Sandhu JS. "Treatment Options for Male Stress Urinary Incontinence." Nat Rev Urol. 2010;7(4):222-8. doi:10.1038/nrurol.2010.26

3. Radadia KD, Farber NJ, Shinder B, et al. "Management of Postradical Prostatectomy Urinary Incontinence: A Review." Urology. 2018;113:13-19. doi:10.1016/j.urology.2017.09.025

4. Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL. "Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024)." J Urol. 2024;212(4):531-538. doi:10.1097/JU.0000000000004088

5. Sacco E, Prayer-Galetti T, Pinto F, et al. "Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up." BJU Int. 2006;97(6):1234-1241. doi:10.1111/j.1464-410X.2006.06185.x

6. Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. "Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions." Ther Clin Risk Manag. 2023;19:43-56. doi:10.2147/TCRM.S283305

7. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-Up." J Urol. 2021;206(5):1106-1113. doi:10.1097/JU.0000000000002239

8. Wolfe AR, Khouri RK Jr, Bhanvadia RR, et al. "Male stress urinary incontinence is often underreported." Can J Urol. 2021;28(2):10589-10594. PMID:33872555

9. Johnson EE, Mamoulakis C, Stoniute A, Omar MI, Sinha S. "Conservative Interventions for Managing Urinary Incontinence After Prostate Surgery." Cochrane Database Syst Rev. 2023;4:CD014799. doi:10.1002/14651858.CD014799.pub2

10. Berghmans B, Hendriks E, Bernards A, de Bie R, Omar MI. "Electrical Stimulation With Non-Implanted Electrodes for Urinary Incontinence in Men." Cochrane Database Syst Rev. 2013;(6):CD001202. doi:10.1002/14651858.CD001202.pub5

11. Prebay ZJ, Foss HE, Wang KR, Chung PH. "A narrative review on surgical treatment options for male stress urinary incontinence." Transl Androl Urol. 2023;12(5):874-886. doi:10.21037/tau-22-629

12. Silva LA, Andriolo RB, Atallah ÁN, da Silva EM. "Surgery for Stress Urinary Incontinence Due to Presumed Sphincter Deficiency After Prostate Surgery." Cochrane Database Syst Rev. 2014;(9):CD008306. doi:10.1002/14651858.CD008306.pub3

13. Abrams P et al. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). 2021. doi:10.1016/j.eururo.2021.01.024.

14. Constable L, Drake MJ, Cooper D, et al. The 24-mo Outcomes from the Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). Eur Urol Focus. 2026 (online 26 August). doi:10.1016/j.euf.2026.07.012

15. Rosenberg JE, Jung JH, Edgerton Z, et al. "Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer." Cochrane Database Syst Rev. 2020;8(8):CD013641. doi:10.1002/14651858.CD013641.pub2

16. Huckabay C, Twiss C, Berger A, Nitti VW. "A urodynamics protocol to optimally assess men with post-prostatectomy incontinence." Neurourol Urodyn. 2005;24(7):622-626. doi:10.1002/nau.20182

17. Sharaf A, Fader M, Macaulay M, Drake MJ. "Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence." Low Urin Tract Symptoms. 2019;11(3):133-138. doi:10.1111/luts.12249

18. Manassero F, Di Paola G, Paperini D, et al. "Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation." J Sex Med. 2012;9(8):2150-2156. doi:10.1111/j.1743-6109.2012.02829.x

19. Yi YA, Keith CG, Graziano CE, et al. "Strong correlation between standing cough test and 24-hour pad weights in the evaluation of male stress urinary incontinence." Neurourol Urodyn. 2020;39(1):319-323. doi:10.1002/nau.24200

20. Eastham JA, Barocas DA, Chu CE, et al. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline Amendment (2026). J Urol. 2026;216(1):2-11. doi:10.1097/JU.0000000000005060. Full guideline: 2022; amended 2026; AUA Board approval February 2026.

21. Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part I: Introduction and Treatment Decision-Making at the Time of Suspected Biochemical Recurrence after Radical Prostatectomy. J Urol. 2024;211(4):509-517. doi:10.1097/JU.0000000000003892

22. Al Hussein Al Awamlh B, Wallis CJD, Penson DF, et al. "Functional Outcomes After Localized Prostate Cancer Treatment." JAMA. 2024;331(4):302-317. doi:10.1001/jama.2023.26491

23. Sacco E, Campetella M, Marino F, et al. "Preoperative Risk Factors for Failure After Fixed Sling Implantation for Postprostatectomy Stress Urinary Incontinence (FORESEE): A Systematic Review and Meta-analysis." Eur Urol Open Sci. 2025;77:58–77. doi:10.1016/j.euros.2025.05.012

24. Uromedica, Inc. ProACT Adjustable Continence Therapy for Men: Physician Instructions for Use. P/N 900136 Rev. A. 2015. FDA-posted IFU.

25. Boston Scientific. AMS 800 Artificial Urinary Sphincter: Instructions for Use (Male). IFU 51266569-01A. Manufacturer IFU.

26. Olson P, Buller D, Antony M, et al. "Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary Sphincters." Urol Pract. 2025;12(2):214-221. doi:10.1097/UPJ.0000000000000750

27. Chung ASJ, Suarez OA, McCammon KA. "AdVance male sling." Transl Androl Urol. 2017;6(4):674-681. doi:10.21037/tau.2017.07.29

28. Deameh MG, Mohamed H, Abdelshafi A, Mohamed T, Ramez M. "Association of Prior Urethroplasty and Technique With Outcomes After Artificial Urinary Sphincter Implantation: A Systematic Review and Meta-analysis." Urology. 2026;214:135-142. doi:10.1016/j.urology.2026.05.024

29. European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male LUTS. 2026. Disease management.