'Efficacy and safety outcomes after slings or artificial urinary sphincter implantation for non-neurogenic male stress urinary incontinence: a systematic review' for more clarity.

Introduction: Our objective was to conduct a systematic review of studies comparing male slings (MS) and Artificial Urinary Sphincter (AUS) in terms of efficacy and safety in men with Stress Urinary Incontinence (SUI). Methods: We conducted a systematic review including all studies comparing MS and AUS in adult men with SUI. All synthetic MS were included. The primary outcome was the postoperative continence rate defined as either no pad use or one safety pad. Results: Of 133 references screened, after exclusion of duplicates, 18 papers were eligible for a full-text analysis and 9 studies (5921 patients) were included in the qualitative synthesis. Among these, one was a randomized controlled trial and eight were cohort studies. The cure rate varied from 14% to 94% for the AUS and 11% to 69% for the MS. Of the five studies reported both devices, two (40%) reported a continence rate above 70% for AUS. Eight of the nine studies (88.9%) reported safety outcomes. Urethral erosion was less frequent after male slings than after artificial urinary sphincter implantation, whereas urinary retention was more frequent after male slings in most studies. Conclusion: In comparative studies, continence proportions were generally higher after artificial urinary sphincter implantation, while the complication profiles of the two devices differ, with more erosion after the sphincter and more urinary retention after the sling. Confidence in these findings is limited by clinical heterogeneity, confounding by indication and inconsistent outcome definitions. Standardised outcome reporting and randomised data are needed. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024539539.