Surgical Management of Male Stress Urinary Incontinence: Artificial Urinary Sphincter Versus Male Slings

Purpose of Review Artificial urinary sphincters and male slings are the primary surgical management options available for male stress incontinence in the USA. In this review, we discuss advances in the assessment of male stress incontinence, the use of artificial urinary sphincters and male slings depending on specific clinical scenarios, and recent research into the use of both treatment options in the irradiated patient. Recent Findings The standing cough test correlates well with 24-h pad weights and is a low-cost and low-burden assessment that can be conducted on initial consultation. For radiated patients, the artificial urinary sphincter is generally recommended, but limited recent data suggest that male slings may be suitable for motivated, appropriately selected patients. While not yet available in the USA, limited early data comparing adjustable male slings to artificial urinary sphincters found improved continence outcomes for AUS. Pre-operative evaluation is imperative in stratifying the severity of incontinence and guiding the choice between artificial urinary sphincters and male slings for male stress urinary incontinence. The surgeon must take into consideration patient medical and surgical history, as well as patient preference, in choosing an AUS versus a male sling, but generally, male slings offer good continence outcomes for mild to moderate SUI while AUS offer superior outcomes for men with more severe stress incontinence.