Factors influencing the choice of urethral slings over artificial sphincter for male stress urinary incontinence

TL;DR

This study explores why urologists choose urethral slings over artificial sphincters for male urinary incontinence, finding that race and certain health conditions influence the decision.

Contribution

The study identifies specific patient characteristics and comorbidities that influence urologists' preference for urethral slings in male stress urinary incontinence.

Findings

African American males are significantly more likely to receive a sling compared to Caucasian males.

Patients with diabetes, hypertension, cancer, and other comorbidities are more likely to be offered slings.

Comorbidities like COPD and heart failure do not influence the choice of treatment.

Abstract

To examine the factors influencing urologists’ decision to offer slings instead of AUS for managing male stress urinary incontinence.

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006–2021 was used to identify patients undergoing surgical procedures for male urinary incontinence using current procedural terminology (CPT) codes. The Current procedural terminology (CPT) codes for AUS (53,445) and male slings (53,440) were used to analyze the data appropriately. The cases with incomplete demographic data were excluded. Patient characteristics of interest were race, age, smoking status, obesity, HTN, COPD, ASA classification, use of glucocorticoids, history of cancer, and diabetes mellitus. Chi square and multivariate logistic regressions were used to identify significant predictors of outcomes. Significance was defined as p<0.05.

Among 4098 patients, 2407 underwent AUS implantation, and 1691 received a sling for male SUI. African American males were significantly more likely than Caucasian males to receive a sling (OR = 5.566, p < 0.05). The patients with comorbidities such as diabetes mellitus, hypertension, use of glucocorticoids, cancer, increased ASA, and history of DVTs are significantly more likely to undergo sling placement. COPD, congestive heart failure, and dialysis had no impact on the choice of male urinary incontinence management.

Male patients who are African American or have comorbidities such as history of diabetes, hypertension, cancer, DVT, and glucocorticoid use were more likely to be offered slings for stress urinary incontinence. These findings suggest a preference among urologists to recommend slings for patients with higher surgical risk profiles.