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UPJ INSIGHT A Full Bladder Is Not Needed for the Male Stress Incontinence Grading Scale

By: Diana Maria Lopategui, MD, Desai Sethi Urology Institute at the University of Miami Miller School of Medicine, Florida; Timothy Demus, DO, Sparrow Hospital, Lansing, Michigan; Chase Mallory, MD, University of Florida, Gainesville, Florida; Kevin George, MD, University of Florida, Gainesville, Florida; Elizabeth Nagoda, MD, Intermountain Health, Sandy, Utah; Anthony Bui, MD, Mount Sinai Medical Center, Miami Beach, Florida; Billy H. Cordon, MD, Mount Sinai Medical Center, Miami Beach, Florida | Posted on: 18 Mar 2024

Lopategui DM, Demus T, Mallory C, et al. A full bladder is not needed for the Male Stress Incontinence Grading Scale. Urol Pract. 2024;11(2):402-408.

Study Need and Importance

Stress urinary incontinence (SUI) can be a devastating consequence of prostatic surgery. Artificial urinary sphincters (AUS) and urethral slings constitute widely accepted surgical treatments. Patient selection is crucial for successful treatment, as sling is indicated for mild incontinence and AUS for moderate to severe incontinence. Current SUI quantification methods, eg, pads per day or pad weight, are subjective and inconvenient. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide objective, reproducible severity stratification. A skeptic may argue that the cough test must be performed with full a bladder; otherwise, it may underestimate SUI severity and increase risk of treatment failure. We used random bladder scans (BS) at time of evaluation to determine if an emptier bladder carries increased failure risk, to confirm the ability of MSIGS to appropriately stratify patients, and to determine if a full bladder is required to correctly assess MSIGS.

What We Found

Thirty-six of 40 patients who underwent sling placement had complete incontinence resolution or reduction to a safety pad vs 40/43 after AUS (90% vs 93%, P = .62). Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). BS mean was 18.5 cc in sling failure (Figure) and 38.0 cc in success groups, with 32% of success patients having BS of 0 cc, and 63% < 50 cc. Mean for AUS patients was 45 cc. Ten patients with BS of 0 cc and 7 patients with BS < 30 cc demonstrated grade 4 incontinence.

Figure. Scatter plot representing the bladder scan value and Male Stress Incontinence Grading Scale (MSIGS) for each patient in the group. AUS indicates artificial urinary sphincter.


The study design is a retrospective review of a single-institution, single-surgeon cohort.

Interpretation for Patient Care

Using a standing cough test, the MSIGS provides a noninvasive, objective, and simple tool for patient stratification in selecting sling vs AUS for male SUI with high success rate. Furthermore, it can be used effectively regardless of bladder fullness at time of assessment.