AUA 2026: Updates on the Management of Lower Urinary Tract Dysfunction

Continence Durability for Male Sling Surgery and Subsequent Pelvic Radiation: A Multicenter Analysis

Authors: Chung Yon Lin, J. Nick Warner, Elizabeth N. Bearrick, Katherine T. Anderson, Christopher E. Wolter, and Bridget L. Findlay

This multi-center retrospective study evaluated urinary outcomes in men who underwent pelvic radiation therapy (RT) after male urethral sling surgery for stress urinary incontinence. Among 666 patients who underwent sling surgery, 17 patients received pelvic RT after sling placement. Median follow-up after radiation was 21 months. Median pad use improved from 2 pads/day before sling surgery to 0 pads/day after sling placement (p<0.01) but increased to 3 pads/day after RT (p<0.01). Social continence, defined as use of ≤1 pad/day, declined significantly from 94% immediately after sling surgery to 12% following RT (p<0.001). Most patients received intensity-modulated radiation therapy (IMRT) for biochemical recurrence at a median dose of 70 Gray (Gy). The median interval between sling placement and RT was 14.9 months. No mesh erosions were reported. However, 17.6% of patients required additional anti-incontinence surgery after RT, including artificial urinary sphincter or adjustable balloon device placement. Overall, pelvic RT after sling surgery was associated with a marked decline in continence outcomes and sling durability.

Evolving Trends and Perioperative Outcomes of Surgical Treatment for Male Stress Urinary Incontinence: Results from the GRAND Study Register

Authors: Yannic Volz, Marc Kidess, Julian Hermans, Troya Georgieva, Ricarda Bauer, Christian Gozzi, Michael Chaloupka, Julian Marcon, Philipp Weinhold, Christian Stief, Gerald Bastian Schulz, and Nikolaos Pyrgidis

This German study evaluated trends and perioperative outcomes of artificial urinary sphincter (AUS), adjustable slings, and non-adjustable slings for male stress urinary incontinence (SUI) between 2005 and 2023. A total of 24,234 men underwent surgery for SUI, including 15,271 (63%) who received AUS, 7,819 (32%) non-adjustable slings, and 1,144 (5%) adjustable slings. Among AUS recipients, 77% received a one-cuff device. AUS remained the most used surgical option, although use of AUS and non-adjustable slings declined over time, while adjustable sling procedures increased. Perioperative mortality was below 0.1% across all groups. Compared with AUS, non-adjustable slings were associated with a slightly higher risk of urinary retention (12% vs 11%; odds ratio [OR] 1.1; p=0.02) but lower wound infection risk (0.7% vs 1.4%; OR 0.5; p<0.001). Median hospital stay was 6 days for AUS and 5 days for sling procedures. Adjustable and non-adjustable slings were associated with shorter hospital stays compared with AUS. Overall, male SUI surgery demonstrated low perioperative mortality, with AUS remaining the standard surgical treatment in Germany.

Barriers to Post-Prostatectomy Stress Incontinence Care: Knowledge Gaps, Patient Concerns, and Urologist Communication

Authors: Martin Baunacke, Viktoria Menzel, Christer Groeben, Falk Hoffmann, Felix KH. Chun, Lothar Weissbach, Johannes Huber, and Christian Thomas

This study evaluated awareness of continence aids and treatment options among men with stress urinary incontinence (SUI) after radical prostatectomy (RP). A total of 99 patients with persistent urinary incontinence after RP were surveyed. Median age at surgery was 67 years, and the median postoperative interval was 11 years. Continuous urinary leakage was reported by 70% of patients, while 53% used more than three pads per day. Pads were the most used continence aid (91%). Awareness of alternative aids was limited, with 86% of patients unaware of condom catheters or penile clamps. Knowledge of surgical treatment options was also low, with 62% of patients unaware of available surgical interventions for incontinence. Younger patients and those using fewer pads were more likely to be aware of surgical treatment options. Information regarding incontinence was mainly provided by urologists (88%), followed by partners (59%) and hospital staff (53%). The most common reasons for not seeking further treatment included coping adequately with continence aids (69%), doubts about surgical effectiveness (55%), and fear of health-related risks (44%). Overall, the study identified substantial gaps in patient awareness regarding continence management and surgical treatment options after RP.

Exploring Patient Perspectives on Sacral Neuromodulation: A Qualitative Analysis of Online Discussions

Authors: Ahmed Albakr, Mohamed Elkhashab, Mazen Mansour, Maria D'Amico, Alexander Koven, and Howard Goldman

This qualitative study analysed patient discussions about sacral neuromodulation (SNM) on Reddit to better understand patient experiences, perceptions, and misconceptions regarding the therapy. A total of 464 discussion threads and 3,413 comments from the subreddits r/Overactive Bladder and r/Incontinence were reviewed. Discussions focused on sacral neuromodulation, InterStim, Axonics, and sacral nerve stimulation. Five major themes were identified: expectations and treatment decision-making, postoperative experiences, device function and performance, emotional and psychosocial responses, and system- or industry-related concerns. Patients commonly discussed concerns regarding candidacy, surgical risks, long-term effectiveness, and comparisons with other third-line therapies. Experiences after treatment ranged from major symptom improvement to persistent discomfort or reduced device effectiveness. Users also discussed differences between InterStim and Axonics devices, including battery life, magnetic resonance imaging (MRI) compatibility, and programming difficulties. Emotional responses included hope, gratitude, frustration, and distrust toward healthcare providers. Concerns related to cost, insurance coverage, and manufacturer support were also frequently reported. Overall, the study highlighted important gaps in patient education and communication regarding SNM and demonstrated the value of social media in understanding patient perspectives.

AUA 2026, May15 – 18, Washington, DC.