Patient selection in all aspects of urology is of utmost importance, and this fact is no different when discussing male stress urinary incontinence (SUI). As nicely outlined in the editorial comment, it seems that the bulk of available literature would support the use of artificial urinary sphincters (AUS) in men with severe SUI. This device has the longest follow-up data available and has proven to be efficacious even in the most incontinent patients. Because of this, we specifically counsel patients with large volume incontinence toward AUS placement. Patients with less severe incontinence or those unable or unwilling to undergo placement of an AUS, however, should be considered for male sling placement. In our practice, those patients electing sling placement despite an increased severity of incontinence and those with a history of previous radiation are extensively counseled on the potential for less optimal outcomes. Specifically, we believe that the likelihood of "cure" rather than "improvement" in this cohort is diminished. However, we have found that thorough preoperative counseling with this high-risk group does help to temper expectations somewhat and can improve postoperative satisfaction.
展开▼
