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Outcomes for Stress Incontinence Procedures for Men and Women With Neurogenic Lower Urinary Tract Dysfunction: A
Javier E Santiago1, Min Soo Choo2, Richard Mora3
1University of Wisconsin School of Medicine & Public Health, Department of Urology, Madison, WI, USA.
Urology
|July 11, 2025
Summary
Treating stress urinary incontinence (SUI) in neurogenic bladder patients shows varied success. Urethral bulking injection (UBI) had shorter durability than artificial urinary sphincter (AUS) or sling procedures in males, and UBI and sling showed limited success in females.
Area of Science:
- Urology
- Neuroscience
- Reconstructive Surgery
Background:
- Stress urinary incontinence (SUI) is a common complication in patients with neurogenic lower urinary tract dysfunction.
- Treatment options for SUI in this population include urethral bulking injection (UBI), sling placement, and artificial urinary sphincter (AUS).
- Efficacy and durability of these procedures may differ between males and females with neurogenic bladder.
Purpose of the Study:
- To compare the efficacy and durability of UBI, sling placement, and AUS for SUI treatment in male and female patients with neurogenic lower urinary tract dysfunction.
- To identify factors associated with procedural failure in these patient groups.
Main Methods:
- Retrospective multi-institutional review of male and female patients with neurogenic lower urinary tract dysfunction undergoing UBI, sling, or AUS for SUI (2012-2020).
- Primary outcome: time to procedural failure (return of SUI symptoms or need for additional procedures).
- Separate analysis for males and females using univariate and multivariable models.
Main Results:
- Forty-five males and 35 females were included; common diagnoses were spina bifida and spinal cord injury.
- In males, 6-month failure rates were UBI-53%, sling-21%, AUS-21%. Median time to failure was shortest for UBI (5.3 months).
- In females, 6-month failure rates were UBI-68%, sling-50%. Median time to failure was shortest for UBI (2.6 months).
- Factors associated with failure included prior bladder reconstruction and spinal cord injury in males, and prior urethral surgery in females.
Conclusions:
- Surgical outcomes for SUI in neurogenic bladder patients differ significantly between sexes.
- Urethral bulking injection demonstrated shorter failure-free survival compared to AUS and sling in males.
- Both UBI and sling placement showed limited durability in females with neurogenic SUI.
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