Outcomes for Stress Incontinence Procedures for Men and Women With Neurogenic Lower Urinary Tract Dysfunction: A Multicenter Neurogenic Bladder Research Group Study

Objective To compare the efficacy and durability of procedures to treat stress urinary incontinence (SUI) in male and female patients with neurogenic lower urinary tract dysfunction. Methods A retrospective multi-institutional review by the Neurogenic Bladder Research Group of male and female patients with neurogenic lower urinary tract dysfunction who underwent urethral bulking injection (UBI), sling placement, or artificial urinary sphincter (AUS) for SUI between 2012 and 2020 was performed. The primary outcome was time to procedural failure, defined as return to baseline preoperative SUI symptoms and/or needing additional procedures for SUI. Men and women were analyzed separately, and univariate and multivariable models were constructed. Results Forty-five males and 35 females were included. The majority had a diagnosis of spina bifida (men—60%, female—28%) or spinal cord injury (men—15%, female—5%). Median age for males was 33 years with median post-operative follow-up of 627 days. Six-month failure rates and median time to failure were: UBI—53% and 5.3 months; sling—21% and 42 months; AUS—21%. Median age for females was 44 years with median post-operative follow-up of 363 days. Six-month failure rates and median time to failure were: UBI—68% and 2.6 months; sling—50% and 7.3 months. Prior bladder reconstruction and spinal cord injury were associated with failure in males; prior urethral surgery was associated with failure in females. Conclusion SUI surgery outcomes differ between males and females with shorter failure-free survival with UBI compared to AUS and sling in males, while UBI and sling placement both demonstrated short failure-free survival in females.