To describe the health characteristics and current treatment choices of male stress urinary incontinence (mSUI) patients to inform patient-centered decision-making.
We identified a cohort of mSUI patients aged ≥65 at UCSF and San Francisco VA. Using retrospective chart review and telephone interviews, we ascertained demographics, incontinence characteristics, Charlson Comorbidity Index (score ≥ 4 indicates significant morbidity), frailty with Timed Up and Go (TUG) test, functional dependence with activities of daily living (ADL), calculated life expectancy, and assessed mental health and quality of life (QOL). Bivariate analysis evaluated associations between subject characteristics and ultimate treatment type (conservative vs. surgery; sling vs. sphincter). Logistic multivariable models evaluating treatment choice were also constructed.
The 130 participants had a mean age of 75 and a mean incontinence score of 14.2 representing moderately bothersome incontinence. Nearly 80% had significant morbidity, three-quarters had >50% 10-year mortality risk, 10% needed help with 1+ADL and 22% had a TUG > 10 seconds indicating frailty. The mean physical and mental QOL scores were similar to the general population. Anxiety and depression were reported by 3.9% and 10%. In univariate and multivariable analysis, only incontinence characteristics were associated with conservative versus surgical treatment choice (p < 0.01).
Multi-morbidity, functional dependence, frailty, and limited life expectancy are common among older men with mSUI, yet current treatment choices appear to be driven by incontinence characteristics. As such, mSUI surgery should be considered among men across the spectrum of health and life expectancy.
Urology. 2021 May 15 [Epub ahead of print]
Lindsay A Hampson, Anne M Suskind, Benjamin N Breyer, Lillian Lai, Matthew R Cooperberg, Rebecca L Sudore, Salomeh Keyhani, I Elaine Allen, Louise C Walter
Department of Urology, School of Medicine, University of California San Francisco; Department of Surgery, San Francisco Veterans Affairs Medical Center. Electronic address: ., Department of Urology, School of Medicine, University of California San Francisco., Department of Urology, University of Michigan Medical School., Department of Urology, School of Medicine, University of California San Francisco; Department of Surgery, San Francisco Veterans Affairs Medical Center., Department of Medicine, School of Medicine, University of California San Francisco; Department of Medicine, San Francisco Veterans Affairs Medical Center., Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco.