Male stress urinary incontinence surgery in Australia: Temporal trends over two decades.

Objective: This study aims to evaluate the national trends in the surgical management of male stress incontinence (SUI) in the Australian population over the 21st century. Methods: Data was sourced from the Australian Institute of Health and Welfare (AIHW) national morbidity database and Medicare Benefits Schedule (MBS) statistics reports. Annual data from financial years (FY) 2000/01 to 2022/23 was collected. Male SUI procedures are grouped into slings, paraurethral bulking agents (PBA) and artificial urinary sphincters (AUS). The annual procedural counts, revisions and yearly changes were obtained. The estimated subsidy burden was reported as AUD per capita (per 100 000 persons). Results: Between FY2000/01 and 2022/23, the aggregate number of male SUI procedures (excluding revisions) increased by 272% (from 288 to 1072). This is largely driven by the increase in AUS procedures, particularly amongst men aged 70-74 years. Male sling procedures demonstrated a substantial early increase followed by plateauing in recent years, while PBA declined over the same period. Revision procedures increased by 444% (from 41 to 223), largely due to AUS revisions and replacement. Over the same period, the estimated aggregate subsidy burden has increased from $13 749 to $53 269 per capita. Conclusion: The surgical management of male SUI in Australia has been transformative over the past two decades. Trends indicate an increase in male SUI procedures, particularly AUS procedures accompanied by an increase in AUS revision and replacement. These trends reflect both expanding surgical demand and durability of continence devices, which has subsequently led to a substantial increase in estimated subsidy burden.