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Incontinence

Urinary incontinence management is organized by clinical phenotype: treatment selection, surgical technique and device options for stress, urgency and mixed presentations in male and female patients.

For SUI after prostate treatment, the 2024 amended guideline recommends that clinicians discuss the artificial urinary sphincter (AUS) for mild to severe SUI and male slings for mild to moderate SUI .[1] It recommends AUS over slings or adjustable balloons after radiotherapy .[1] In the MASTER trial (n = 380 randomized), the sling was noninferior to AUS on the primary endpoint of patient-reported incontinence at 12 months after randomization (134/154 [87.0%] versus 133/158 [84.2%] still incontinent by the strict definition).[3] Secondary outcomes favored AUS.[3] At 24 months, the sling met the noninferiority margin for strict patient-reported continence (responses of “never” and “none” to the ICIQ-UI SF leakage items; 21/140 [15%] versus 22/148 [15%]); noninferiority was not established on the less-strict definition.[6] Further surgery was more frequent after sling (20 men, 11%) than after AUS (4 men, 2%).[6]

Pelvic-floor training and behavioral strategies are conservative options; treatment selection and sequencing depend on phenotype, bother, severity, prior radiation, urethral health, comorbidity and patient preference.[1][2][4][5] For OAB, clinicians may offer minimally invasive therapy through shared decision-making without requiring trials of behavioral, noninvasive or pharmacologic management .[4]

References​

1. American Urological Association. Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2019; amended 2024).

2. European Association of Urology. Management of Non-neurogenic Male LUTS, disease management: urinary incontinence. Accessed September 2026.

3. Abrams P, Constable LD, Cooper D, et al. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). Eur Urol. 2021;79(6):812–823. doi:10.1016/j.eururo.2021.01.024

4. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol. 2024;212(1):11–20. doi:10.1097/JU.0000000000003985

5. Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023). J Urol. 2023;209(6):1091–1098. doi:10.1097/JU.0000000000003435

6. 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