Surgical management of male urinary incontinence following radiation therapy for prostate cancer: a review

Purpose of Review: This review evaluates the surgical management of male urinary incontinence (UI) following radiation therapy (RT) for prostate cancer, focusing on artificial urinary sphincters (AUS) and male urethral slings. It aims to assess recent evidence on the impact of RT on surgical treatment options for post-prostatectomy incontinence. Recent Findings: Recent findings indicate that male urethral slings have lower success rates and higher complication rates in patients who have undergone prior RT. Conversely, although the AUS is the gold standard for treating post-prostatectomy UI, it also exhibits poorer outcomes and higher complication rates in post-RT patients compared to those without RT. Some recent studies suggest that administering RT after AUS implantation is associated with better continence outcomes, without increasing the risk of complications. Various techniques have also recently been developed to address urethral atrophy and persistent UI following AUS implantation, including the use of tunica albuginea flaps and downsizing to a 3.5 cm AUS cuff. It must be noted that despite increased complications, quality of life outcomes remains very favourable for patients who are post-RT and undergoing AUS implantation. The 7th International Consultation on Incontinence strongly recommends AUS as the surgical option for the post-prostatectomy incontinent male who has undergone RT. Summary: In summary, AUS implantation significantly enhances continence and quality of life for RT patients, despite the increased risk of complications. Optimising outcomes in managing male UI post-RT requires tailored surgical approaches, thorough preoperative assessments, and realistic patient counselling.