Presentation Authors: Yooni Yi*, Rachel Bergeson, Nabeel Shakir, Michael Davenport, Allen Morey, Dallas, TX
Introduction: While surgical decision making for men with mild or severe stress urinary incontinence (SUI) is relatively straightforward, treatment options for men with moderate SUI are less clear cut. We hypothesized that men referred for treatment of moderate SUI often have unexpectedly high degrees of SUI observed during focused physician examination in a subspecialty clinic. We evaluated the percentage of men who demonstrated degrees of incontinence beyond the level for which they were referred.
Methods: A retrospective review of our large single surgeon male SUI database was completed. Men having artificial urinary sphincter (AUS) and AdVance sling procedures between the years 2007 and 2017 were included in the analysis. Moderate SUI patients were defined as those reporting 2-3 pads leakage per day (PPD) by history. SCT results were stratified by the Male Stress Incontinence Grading Scale (MSIGS); sling outcomes were compared between various MSIGS groups. Sling failure was defined as greater than 1 PPD usage or need for AUS.
Results: A total of 475 patients underwent either a sling (n = 215) or AUS (n = 260) during the study interval with both PPD and MSIGS data available. Among 169 patients reported to have moderate incontinence (2-3 PPD), 76 (45%) were noted to have an MSIGS score indicating a severe level of incontinence. Within the moderate SUI cohort, sling failure rates were found to be 44.3% for MSIGS 0-2 vs 64.2% for the MSIGS 3-4 group. The overall failure rate of moderate SUI sling patients was higher than the mild SUI sling group (47.3 % vs. 15.3%, p < 0.0001). AUS patients were more likely to have been upgraded by MSIGS grading (81.5%) compared to sling patients (15.1%) indicating the impact of MSIGS grading on stratifying patients who report moderate stress incontinence.
Conclusions: Discordance is common between the degree of SUI reported by patient history and the severity actually demonstrated during SCT. The physical demonstration of SUI using a SCT provides important prognostic information for anti-incontinence surgery.