Prolonged Duration of Incontinence for Men Before Initial Anti-incontinence Surgery: An Opportunity for Improvement

OBJECTIVE To evaluate the duration and severity of male incontinence symptoms before presentation for initial anti-incontinence surgery (AIS) in a large tertiary subspecialty practice. Although male stress urinary incontinence (SUI) is known to profoundly compromise quality of life, many men do not undergo AIS in a timely manner. MATERIALS AND METHODS We retrospectively reviewed our male patients with SUI (2007-2017) and assessed time from SUI onset to initial AIS across various demographics comparing male sling and artificial urinary sphincter (AUS). Reoperative cases were excluded. RESULTS Among 786 cases, 572 men undergoing initial AIS met the inclusion criteria (mean age 69 years), with 57.7% (330/572) undergoing AUS and 42.3% (242/572) undergoing sling. The median duration of incontinence before AIS was 32 months. AUS patients pursued surgical intervention earlier than men undergoing sling (median time 28.8 months vs 34.7 months, P =.03). Most patients deferred AIS for more than 2 years (69.8% of sling patients and 58.5% of AUS patients), and 32.3% demonstrated an extended delay of more than 5 years. Increasing age correlated with delays in both AUS (Spearman rho = 0.20, P =.0001) and sling (Spearman rho = 0.34, P <.0001). On multivariate analysis, age was significantly associated with duration of incontinence (P <.0001). Octogenarians had a notably higher median delay of 87.4 months. CONCLUSION Although the median duration of SUI before the initial AIS is 2.7 years, one-third of men experience a delay of more than 5 years. AUS present for AIS 6 months less on average relative to sling patients. Older men demonstrate a longer duration of SUI before seeking surgical care. (C) 2018 Elsevier Inc.