Safety and efficacy of artificial urinary sphincter versus male slings in treatment of male urinary incontinence: Systematic review and meta-analysis

Background and objective:

Male stress urinary incontinence (UI) remains a serious problem associated with a significant quality of life reduction. The aim of this study is to determine the safety and effectiveness of artificial urinary sphincter (AUS) and male slings (MS) for stress UI in men.

Evidence acquisition:

Inclusion criteria: randomized/non-randomized trials evaluating adult men with stress UI. Exclusion criteria: repeated SUI surgery, combined conservative interventions and pharmacological treatment. The electronic databases were searched up to January 2024. The systematic review was conducted according to PICO framework and PRISMA 2020 guidelines and was registered in PROSPERO. The risk of bias was evaluated using the tools recommended by the Cochrane Society.

Evidence synthesis:

Thirteen clinical trials were included in the systematic review, and 11 in the meta-analysis. There was no statistically significant difference in the improvement rate between AUS and MS (RR $=$ 0.93, 95% CI: [0.85, 1.02], p$=$ 0.13). MS showed statistically significant fewer infectious complication (RR $=$ 3.26, 95% CI: [1.97, 5.39], p<0.00001), device explantation (RR $=$ 3.29, 95% CI: [2.46, 4.41], p<0.00001), surgical revision (RR $=$ 2.27, 95% CI: [1.60, 3.20], p<0.00001), urinary retention (RR $=$ 0.04, 95% CI: [0.01, 0.07], p $=$ 0.004) rates and operation time (RR $=$ 0.93, 95% CI: [0.85, 1.02], p $=$ 0.13) compared with AUS.

Conclusion:

AUS demonstrates a comparable improvement level to MS. The operation time, infectious complication, device explantation, urinary retention, and surgical revision rates were lower in MS. More randomized and prospective studies with long-term follow-up will further increase confidence in the choice between AUS and MS for male UI treatment.