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UPJ INSIGHT: Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From AUA Quality Registry
By: Hasan Dani, MD; William Meeks, BA; Cody Weiss, BA; Raymond Fang, MSc; Andrew J. Cohen, MD | Posted on: 16 Feb 2023
Dani H, Meeks W, Weiss C, Fang R, Cohen AJ. Patterns of surgical management of male stress urinary incontinence: data from the AUA quality registry. Urol Pract. 2023;10(1):66-73.
Study Need and Importance
Surgical treatment for male stress urinary incontinence (SUI) is underutilized. Prior studies have reported that urethral bulking was the most commonly performed, despite lack of high-quality data supporting its use. There is a need for a contemporary analysis of male SUI practice patterns.
What We Found
Most patients with male SUI do not receive surgical intervention, and rates of intervention dropped further during the COVID-19 pandemic. Artificial urinary sphincter (AUS) was the most commonly performed procedure for male SUI, followed by urethral sling and then urethral bulking; there was no significant change in the volume of each procedure during the study period of 2014 to 2020 (see Figure). A large proportion of the total urethral bulking was performed by a disproportionately small number of practices. Patients with a history of radical prostatectomy, urethroplasty, or care at an academic center were more likely to undergo an open surgical procedure (eg, AUS or sling) rather than urethral bulking.
Limitations
The AUA Quality (AQUA) registry does not have granular data available regarding baseline symptoms, efficacy outcomes, and indications for repeat surgery. Furthermore, it is challenging to identify patients who may have received additional surgical treatment for male SUI either prior to entry into an AQUA practice or after departure from an AQUA practice.
Interpretation for Patient Care
It is encouraging that utilization of urethral bulking is now lower than that of urethral sling or AUS. Data from the AQUA registry can help identify practices and patients more likely to use urethral bulking, thus facilitating further improvement towards evidence-based and guideline-adherent care.
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