The MASTER trial is a randomised controlled trial (RCT) conducted among men with bothersome urodynamic stress urinary incontinence (SUI) recruited from 27 UK centres [1]. This secondary analysis aimed to determine whether baseline severity of urinary incontinence (UI) affects quality of life (QoL) and patient satisfaction (PS) following male SUI surgery.

Participants were randomly assigned (1:1) to the male transobturator sling (MTS) (n=190) or artificial urinary sphincter (AUS) (n=190) group. QoL outcome measures included interference on everyday life (ICIQ-UI SF) and satisfaction with treatment (ICIQ-satisfaction) assessed at 12 months. Baseline UI severity was assessed by 24-hour pad weight and ICIQ-UI-SF questions “how often do you leak urine?” and “how much urine do you leak?”.

Baseline UI severity was comparable between MTS and AUS groups across ICIQ-UI SF scores, number of pads used, and 24-hour pad weights. In participants with a 24-hour pad weight >400g at baseline, urinary symptom interference at 12 months was significantly worse for MTS (3.4) compared to AUS (2.1) (p=0.028). Participants reporting baseline leakage frequency of "several times a day" on the ICIQ-UI SF also had worse QoL if treated with MTS (3.5) vs AUS (2.6) (p=0.003). Among participants with baseline 24-hour pad weight >400g, rates of satisfaction and very high satisfaction with surgery were significantly higher with AUS compared to MTS: 97.7% vs 70.5% (p=0.006) and 74.4% vs 43.2% (p=0.003) respectively. Similar statistically significant differences favouring AUS were observed in satisfaction analyses using ICIQ-UI SF as the baseline severity measure.

In men with severe UI at baseline, the AUS appears to confer superior QoL and PS outcomes compared to MTS at 12 months. These findings suggest that baseline UI severity should be considered when counselling patients about surgical options for male SUI.

In this secondary analysis of the MASTER RCT, men with severe UI at baseline demonstrated better QoL and patient satisfaction following AUS implantation compared to MTS. Baseline UI severity should be incorporated into shared decision-making when selecting surgical intervention for male SUI.

Abrams P, Constable LD, Cooper D, MacLennan G, Drake MJ, Harding C, Mundy A, McCormack K, McDonald A, Norrie J, Ramsay C, Smith R, Cotterill N, Kilonzo M, Glazener C; MASTER Trial Team. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). Eur Urol. 2021 Jun;79(6):812-823. doi: 10.1016/j.eururo.2021.01.024.