Standing cough test stratification of moderate male stress urinary incontinence

Abstract

Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.

A narrative review of the role of the Male Stress Incontinence Grading Scale in the surgical management of male stress urinary incontinence

“…Furthermore, patients with self-reported moderate SUI (2-3 PPD) can be stratified into favorable (MSIGS 0-2) or unfavorable (MSIGS 3-4). In our experience, the success rates (defined as 1 or fewer PPD) following male sling placement in the favorable group are significantly higher than the unfavorable group (64% vs. 33%) (28). When comparing male slings to AUS for moderate SUI, AUS outperformed the sling with success rates of 80% compared to 63%, despite the AUS group having significantly higher baseline PPD and baseline MSIGS.…”

A Full Bladder Is Not Needed for the Male Stress Incontinence Grading Scale

“…Further studies validated this test for patient selection, showing that men with moderate to severe SUI (MSIGS grades 2 or 3) had as higher rate of SUI resolution with placement of an AUS than a sling, 9 and men with an MSIGS grade 0 to 2 who underwent sling placement had a significantly higher success rate than those with MSIGS 3 or 4. 10 In our cohort, men with MSIGS 2 were advised to undergo AUS if they had prior history of radiation, as recommended by the AUA guidelines on incontinence after prostate treatment. 4 In all other cases, the decision was made on an individual basis after cystoscopic evaluation of residual external sphincter function and additional discussion surrounding patient expectations, priorities, benefits, and disadvantages of the options.…”

Editorial Comment

“…1 Use of the Male Stress Incontinence Grading Scale (MSIGS) has been shown to effectively stratify men for artificial urinary sphincter placement vs male sling based on severity of leakage during a standing cough test. 2 The primary criticism of the standing cough test is that bladder volume is not routinely assessed prior to evaluation, raising the concern that the degree of stress incontinence may be underestimated if the bladder is relatively empty. This becomes particularly important for the scenario where the patient has voided just prior to checking in to their clinic appointment, and the urologist is faced with the question of waiting for the patient to drink water and obtain a full bladder (potentially disrupting clinic flow) or bringing the patient back for an additional visit (and thus overburdening the clinic).…”

“…1 Use of the Male Stress Incontinence Grading Scale (MSIGS) has been shown to effectively stratify men for artificial urinary sphincter placement vs male sling based on severity of leakage during a standing cough test. 2…”