Continence Durability for Male Sling Surgery and Subsequent Pelvic Radiation: A Multicenter Analysis

To evaluate urinary continence outcomes in males who underwent pelvic radiation therapy (RT) before versus after urethral sling placement.

We performed a retrospective study of males undergoing urethral sling placement for stress urinary incontinence at three tertiary centers from 2010 to 2025. Patients with history of pelvic radiation were stratified into two cohorts: sling placement before radiation (pre-RT) and sling placement after radiation (post-RT). The primary outcome was continence durability, assessed by pad use. Social continence was defined as the use of ≤1 pads per day (ppd). Secondary outcomes included International Prostate Symptom Score (IPSS), complications, and salvage surgery.

Of 666 males undergoing sling placement, 28 (4.2%) had history of pelvic radiation: 15 (2.3%) pre-RT and 13 (2.0%) post-RT. In the pre-RT cohort, 100% experienced social continence post-sling; however, subsequent radiation resulted in marked deterioration, with social continence declining to 11% and median pad use increasing from 0 to 3 ppd. In the post-RT cohort, 50% of men achieved social continence post-sling. No mesh erosions were observed. Salvage artificial urinary sphincter (AUS) placement was performed in 21% (6/28) of the entire cohort, with no significant difference between the pre-RT and post-RT groups (13% vs. 31%; p = 0.37).

In this retrospective cohort, pelvic radiation after sling placement was temporally associated with declining continence in some patients. Both a history of pelvic radiation and the potential future need for radiation should be considered during counseling and selection of surgical treatment for stress urinary incontinence.