Most reports on male urinary incontinence (UI) focus solely on post-prostatectomy cases.
This study aimed to provide a broader overview of UI after different pelvic and outlet surgeries — including prostatectomy, TURP,
laser, and urethral interventions — to assess how surgical history affects leakage burden and initial treatment strategy in real-world
practice.

We retrospectively analyzed 195 men treated for UI between January 2023 and June 2025.
Collected parameters included age, BMI, type of prior surgery, pelvic radiation, stricture disease, and bladder dysfunction.
UI burden was assessed by pad-tests, pads per day, 3-day voiding diaries, and ICIQ-UI SF / QoL scores.
Initial treatment was classified as conservative, male sling, artificial urinary sphincter (AUS), or botulinum toxin (BoNT-A).
Early postoperative (<8 weeks) and primary neurogenic cases were excluded.
Comparisons across subgroups were performed using Mann–Whitney U or χ² tests.

Mean age was 67.6 ± 11.8 years, BMI 28.2 ± 3.8 kg/m².
Prior procedures: prostatectomy 61.5% (open 21.5%, laparoscopic 23.1%, robotic 16.9%), outlet surgery 34% (TURP 15.9%, laser
6.2%), stricture-related 25%, and pelvic radiation 22% (mostly external beam).
Median pad use was 3 (2–5)/day and 24-h pad-test 420 g (180–890); 27% reported nocturnal leakage.
Leakage burden was highest after open prostatectomy and lowest after robotic surgery (median 24-h pad-test 610 g vs 240 g, p =
0.004). Patients with pelvic radiation had significantly greater daily pad loss compared with non-irradiated men (570 g vs 350 g, p =
0.009). Nocturnal leakage occurred more often in irradiated cases (42% vs 22%, p = 0.021).
In multivariable analysis, radiation independently predicted higher pad-weight (p = 0.014).
Treatment reflected this gradient: AUS used in 28.2% (predominantly high-burden or irradiated cases), slings in 24.6% (moderate
post-prostatectomy leakage, mainly non-irradiated), BoNT-A in 8.7%, and conservative therapy in 21.0%.
AUS implantation was more frequent in irradiated vs non-irradiated men (41% vs 24%, p = 0.032).
Patients achieving continence (≤1 pad/day) showed significant QoL improvement (p < 0.001)

The findings indicate that male urinary incontinence following pelvic surgery represents a heterogeneous clinical condition shaped by the type of prior intervention and the presence of additional risk factors such as pelvic radiation. The observed gradient in leakage severity suggests that continence outcomes are not determined solely by prostatectomy itself but also by the surgical approach and cumulative tissue injury. The higher leakage burden after open prostatectomy compared with robotic procedures likely reflects differences in surgical trauma and preservation of periurethral support structures.
Pelvic radiation emerged as a particularly important modifier, independently associated with greater urine loss and more frequent nocturnal leakage. This supports the concept that radiation-induced tissue fibrosis and vascular compromise significantly worsen functional outcomes.
Treatment patterns observed in the cohort closely followed this severity gradient. More invasive options, particularly artificial urinary sphincter implantation, were preferentially used in patients with severe or radiation-associated incontinence, whereas slings and conservative therapy were more common in moderate, non-irradiated cases. Overall, these results emphasize the importance of considering the entire surgical history when selecting optimal management strategies.

Male urinary incontinence arises from a wide range of surgical backgrounds, not limited to prostatectomy.
Leakage severity follows a clear pattern: it is highest after open prostatectomy and radiation, intermediate after laparoscopic or outlet
surgery, and lowest after robotic procedures.
Treatment choices mirror this gradient, with AUS favored in severeor irradiated patients and slings or conservative care in moderate,
non-irradiated cases.
Understanding these patterns enables more personalized counselling and better resource planning for continence care services.

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