Comparative analysis of male stress urinary incontinence treatments: A review of efficacy, safety, and clinical outcomes

Background: Male stress urinary incontinence (MSUI) is a distressing condition that often results from radical prostatectomy, transurethral resection of the prostate, or other pelvic procedures. Despite the limitations of artificial urinary sphincters (AUS), they have historically been considered the gold standard. Emerging treatments offer varying efficacies and safety levels. This study aimed to evaluate and compare the efficacy, safety, and clinical outcomes of current MSUI treatment modalities, including AUS, adjustable transobturator male system (ATOMS), Pro Adjustable Continence Therapy, AdVance Non-adjustable Male Sling System, and duloxetine. Methods: PubMed, covering prospective and retrospective analyses of MSUI treatments in postprostatectomy patients, was searched for relevant studies published between 2006 and 2024. Data on treatment efficacy (dry matter rate, improvement rate, and reduction in incontinence severity) and safety outcomes (complication and explanation rates) were extracted. Results: A total of 46 studies comprising 7841 patients were analyzed. Artificial urinary sphincters demonstrated the highest dryness rate (72.03%), whereas ATOMS had the highest improvement rate (85.56%) and the lowest surgical explantation risk (9.45%). Pro Adjustable Continence Therapy and AdVance yielded moderate efficacy, whereas duloxetine had the lowest complication rate (18.79%). Conclusions: Artificial urinary sphincters may be the most effective treatment for dryness, whereas ATOMS could offer high improvement rates with a lower risk of explantation and complications. Duloxetine demonstrated a strong safety profile as a pharmacological option, although the evidence remains limited. Given the heterogeneity of the existing studies, future prospective randomized trials are needed to refine treatment selection and optimize MSUI management.