Search

Radical prostatectomy is the most common cause of urinary stress incontinence in male patients. The exact pathophysiology is not clearly defined but probably due multifactorial. Thorough preoperative diagnostic workup before surgical therapy appears to be crucial for good postoperative results. Various systems are available. The artificial urinary sphincter continues to be considered standard procedure with a high success rate, even in patients with more complex situations and severe urinary incontinence. However, there are also relevant complication and revision rates. Modern alternatives include various sling systems. The adjustable sling systems consist of a cushion that is placed against the urethral bulb and leads to a permanent increase in urethral resistance, which can be readjusted in different ways depending on the system implanted. The adjustable sling systems also seem to be an alternative in patients with a prior history of radiation therapy. The AdVance XP sling (Boston Scientific, Marlborough, MA, USA) is a fixed sling that corrects the postoperative hypermobility of the posterior urethra after radical prostatectomy and, thus, leads to a longer functional urethral length. Good long-term results after AdVance XP implantation are only possible in selected patients., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Male stress urinary incontinence is predominantly iatrogenic, whereby radical prostatectomy is the most frequent cause. The first-line treatment of postoperative stress urinary incontinence is physiotherapy, in which training of pelvic floor muscles and sphincter play a major role. If conservative treatment fails surgical treatment is recommended. Nowadays, various options are available for the surgical treatment of stress urinary incontinence in men. Therefore, every patient with persistent postoperative urinary incontinence with psychological strain and desire for treatment should be offered surgical treatment. The selection of the surgical method should primarily be made depending on the contraindications.

In this narrative review, we give an overview of contemporary conservative treatment concepts for urinary incontinence in female patients. Hereby, we focus on pure stress urinary incontinence, urge incontinence and mixed urinary incontinence. We emphasise the value of rationally used diagnostic methods to be able to distinguish between these subentities. Regarding conservative treatment options, we focus on life-style changes, pelvic floor muscle training and drug treatment, and we discuss the results of recent studies. In addition, we provide current expert opinions and recommendations to facilitate the integration of these findings into the daily clinical routine., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)