The effect of surgical intervention for stress urinary incontinence (UI) on post‐prostatectomy UI during sexual activity

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It is well recognized that RP is associated with short‐ and long‐term SUI and erectile dysfunction. The incidence, clinical significance and treatment of UI during sexual activity is less well understood. The present study demonstrates the effectiveness of both an AUS and male sling to improve sexual QOL in men presenting with both SUI and UI during sexual activity. OBJECTIVE • To determine the impact of anti‐incontinence surgical procedures (artificial urinary sphincter [AUS] or male sling) on bother due to urinary incontinence (UI) during sexual activity after radical prostatectomy (RP). PATIENTS AND METHODS • Between October 2000 and December 2007, 27 men in a large single‐surgeon RP series underwent anti‐incontinence surgery with an AUS or male sling. • In all, 16 of these 27 men completed a questionnaire retrospectively capturing bother attributable to UI during arousal and orgasm and the impact of the AUS/male sling on UI and sexual quality of life (QoL). RESULTS • In all, 15 men were evaluable. Of these, 11 were sexually active; four and seven men underwent AUS and sling placement, respectively. • All 11 men had a marked improvement in stress UI symptoms, which was the primary indication for surgery. • All men undergoing AUS had an improvement in their sexual QoL, and most (three of four men) indicated marked improvement. • Slightly more than half of men undergoing the sling procedure reported marked improvement in sexual QoL. CONCLUSIONS • Our study shows a beneficial effect of anti‐incontinence surgery on UI during sexual activity. • Whether these surgical approaches would benefit men with significant bother due to UI limited to sexual activity warrants further investigation.