Topic: Stress Urinary Incontinence

In the first part of this urologic debate, Brian S. Christine, MD, Director of Prosthetic Urology and Men’s Sexual Health at Urology Centers of Alabama in Birmingham, argues that the sling is the best treatment for post-prostatectomy stress urinary incontinence in men. He goes over how to select the right candidates for a sling, the pre- and post-operative procedural steps, and the resulting success rate. Dr. Christine notes that slings are best used in patients with mild to moderate stress urinary incontinence as determined by a severity grading system. He considers two options for determining incontinence severity, the pad test and the standing cough test, observing that the latter is preferable given that it is done in-office versus by the patient at home. Dr. Christine then provides a detailed explanation of the surgical steps and technique using an AdVance XP male sling. He concludes that the sling, when used on the ideal candidate with a standing cough test grade of 0, 1, or 2, results in a post-operative success rate of 82-83% of patients who are dry or pad-free. Alexander Gomelsky, MD, FACS, argues in favor of using an artificial urinary sphincter in the second part of the debate here.