Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics. As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.