Male urinary incontinence (UI) after pelvic surgery remains a complex and heterogeneous condition with multiple overlapping
causes. Existing classifications focus mainly on post-prostatectomy incontinence and fail to capture the full spectrum of etiologic
factors seen in daily practice. To address this gap, we developed the MI-CRONS classification — a simple, structured coding system
that describes each male UI case through its key etiologic components: C (cancer surgery), R (radiation), O (outlet obstruction or
device-related), N (neurogenic or functional dysfunction), and S (stricture disease), combined with a standardized four-grade severity
scale (I–IV). This study aimed to evaluate its clinical applicability, reproducibility, and ability to reflect the real-world diversity of male
UI after various pelvic procedures.

A retrospective observational study included 195 men treated for UI between January 2023 and June 2025.
Clinical histories, operative notes, and urodynamic reports were reviewed independently by two investigators who assigned a unique
MI-CRONS code to each patient.
Discrepancies were resolved by consensus, and inter-observer reliability was calculated using Cohen's κ.
Incontinence severity was determined by daily pad use, voiding diaries, and patient-reported bother (ICIQ-UI SF when available).
Associations between etiologic patterns and incontinence grade were analyzed using chi-square and Spearman correlation tests.
Subgroup comparisons were performed for isolated versus combined MI-CRONS profiles to assess construct validity.

Mean age 67.6 ± 11.8 years, BMI 28.2 ± 3.8 kg/m².
Etiologic distribution: C 61.5 %, R 22 %, O 34 %, N 23 %, S 25 %; combinations were observed in 46 % of cases, most frequently C
+ R (14 %) and C + S (11 %).
Severity grades: I 21 %, II 41 %, III 30 %, IV 7 %.
The C + R and C + S subgroups showed the highest proportion of grade III–IV patients (71 % vs 32 % in single-factor cases, p <
0.01).
Men with active outlet obstruction (O) had more frequent urge or mixed components, while those with strictures (S) showed
predominantly stress-type leakage.
No significant correlation was found between age or BMI and MI-CRONS severity (p > 0.1).
Inter-observer agreement for MI-CRONS assignment reached κ = 0.91.
The system successfully covered > 95 % of all clinical scenarios and enabled straightforward differentiation between post-oncologic,
post-radiation, and reconstructive etiologies.

The findings demonstrate that male urinary incontinence after pelvic surgery rarely results from a single etiologic factor. Nearly half of patients presented with combined MI-CRONS profiles, confirming that postoperative incontinence is typically multifactorial rather than purely sphincteric. The markedly higher proportion of severe incontinence in the **C+R** and **C+S** subgroups highlights the cumulative effect of surgical sphincter damage combined with radiation-induced tissue changes or urethral scarring. This supports the concept that continence outcomes are strongly influenced by the interaction of multiple mechanisms rather than isolated surgical events.
The MI-CRONS coding system can be applied consistently across clinicians, suggesting strong reproducibility in routine practice. Importantly, the classification captured more than 95% of real-world clinical scenarios, indicating that it adequately reflects the complexity of male urinary incontinence encountered after pelvic interventions.
Overall, these results suggest that MI-CRONS provides a practical framework for identifying

The MI-CRONS classification provides a reproducible, mechanism-based framework for describing the etiology and severity of male
urinary incontinence. It standardizes data recording, supports patient stratification, and enables uniform comparison of outcomes
across studies.
MI-CRONS transforms complex surgical histories into a clear, structured clinical profile.

Kasyan, G., Grigoryan, B., & Pushkar, D. (2024). A novel clinical classification for male urinary incontinence: MI-CRONS. Continence Reports, 10, 100051.