Male Stress Urinary Incontinence
Male stress urinary incontinence (SUI) most commonly results from sphincteric insufficiency following radical prostatectomy, radiation therapy, TURP, or trauma to the external urethral sphincter. Treatment selection depends on incontinence severity (pad count, pad weight), prior radiation, urethral health, patient dexterity, and preference. Options range from conservative (pelvic floor rehabilitation, penile compression) to surgical (slings, adjustable devices, AUS).
5 of 5 treatments
| Treatment | Category | Notes |
|---|---|---|
| Pelvic Floor Physical Therapy | Conservative | Canonical supervised PFPT/PFMT program for post-prostatectomy SUI: correct sphincter recruitment, endurance, quick contractions, coordination, and avoidance of abdominal/gluteal substitution. Best started early; biofeedback or electrical stimulation can be added selectively. |
| Penile Clamp | Conservative | External compression device applied to the penile shaft to occlude the urethra and prevent leakage. Temporizing measure for mild-to-moderate SUI; not suitable for long-term use due to risk of urethral erosion, pressure necrosis, and skin breakdown. |
| Male Urethral Sling | Surgical | Retropubic or transobturator mesh sling provides passive urethral coaptation. Best suited for mild-to-moderate SUI (1–3 PPD) without prior radiation or urethral compromise. AdVance and AdVance XP slings are the most widely used designs. |
| Adjustable Continence Devices | Surgical | Adjustable periurethral balloons (e.g., ProACT) allow postoperative titration of urethral resistance without device replacement. Suitable for moderate SUI; adjustability is advantageous after radiation where progressive fibrosis alters urethral compliance. |
| Artificial Urinary Sphincter (AUS) | Surgical | AMS 800 is the gold standard for moderate-to-severe male SUI. Hydraulic cuff occludes the bulbar urethra; patient-activated pump cycles device for voiding. 5-year continence (0–1 PPD) ~70–85%; revision rate ~20–30% at 10 years. |