Prolonged Duration of Incontinence for Men Before Initial Anti-incontinence Surgery: An Opportunity for Improvement

Objective: To evaluate the duration and severity of male incontinence symptoms before presentation for initial anti-incontinence surgery (AIS) in a large tertiary subspecialty practice. Although male stress urinary incontinence (SUI) is known to profoundly compromise quality of life, many men do not undergo AIS in a timely manner. Materials and Methods: We retrospectively reviewed our male patients with SUI (2007-2017) and assessed time from SUI onset to initial AIS across various demographics comparing male sling and artificial urinary sphincter (AUS). Reoperative cases were excluded. Results: Among 786 cases, 572 men undergoing initial AIS met the inclusion criteria (mean age 69 years), with 57.7% (330/572) undergoing AUS and 42.3% (242/572) undergoing sling. The median duration of incontinence before AIS was 32 months. AUS patients pursued surgical intervention earlier than men undergoing sling (median time 28.8 months vs 34.7 months, P =.03). Most patients deferred AIS for more than 2 years (69.8% of sling patients and 58.5% of AUS patients), and 32.3% demonstrated an extended delay of more than 5 years. Increasing age correlated with delays in both AUS (Spearman rho = 0.20, P =.0001) and sling (Spearman rho = 0.34, P <.0001). On multivariate analysis, age was significantly associated with duration of incontinence (P <.0001). Octogenarians had a notably higher median delay of 87.4 months. Conclusion: Although the median duration of SUI before the initial AIS is 2.7 years, one-third of men experience a delay of more than 5 years. AUS present for AIS 6 months less on average relative to sling patients. Older men demonstrate a longer duration of SUI before seeking surgical care.