Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence Among Certifying American Urologists.
OBJECTIVE
To examine case volume characteristics among certifying urologists performing male sling and artificial urinary sphincter (AUS) procedures to evaluate practice patterns in male stress urinary incontinence (SUI).


METHODS
Six-month case log data of certifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying Current Procedural Terminology code for male sling, AUS, and removal or revision of either procedure in males ≥18 years were analyzed.


RESULTS
Among 1615 urologists (568 certifying and 1047 recertifying) logging at least 1 male incontinence procedure, 2109 (48% of all procedures) male sling and 2284 (52%) AUS cases were identified. The mean age of patients undergoing AUS was 74.9 years and the mean age of patients undergoing sling procedures was 67.3 years (P <.001). An increase in male incontinence procedures from 2003 to 2013 was demonstrated. The rate of male sling procedure increased from 32.7% of incontinence surgeries in 2004 to 45.5% in 2013 (P <.001). Academically affiliated urologists are 1.5 times more likely to perform AUS than male sling for SUI (P <.001). Median number of slings performed was 2 (range 1-40), with 32.7% placing slings exclusively. A small group of certifying urologists (3.4%) accounted for 22% of all male slings placed. This same cohort logged 10.2% of all AUS performed. Surgical management of male SUI varies widely across states (P <.001), with slings performed between 21% and 70% of the time.


CONCLUSIONS
Overall the number of male incontinence procedures has increased over time, with a growing proportion of male slings. Most slings and AUS cases are performed by a small number of high-volume surgeons.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Joceline S
JS
Liu
Department of Urology, University of Texas Southwestern, Dallas, TX.
Matthias D
MD
Hofer
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Jaclyn
J
Milose
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Daniel T
DT
Oberlin
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Sarah C
SC
Flury
Department of Urology, University of Texas Southwestern, Dallas, TX.
Allen F
AF
Morey
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Case Western Reserve University, Cleveland, OH. Electronic address: christopher.gonzalez@UHhospitals.org.
Chris M
CM
Gonzalez
D000368:Aged; D002568:Certification; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000706:statistics & numerical data*; D066231:Surgeons / Q000592:standards*; D014481:United States; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000706:statistics & numerical data*; D013521:Urologic Surgical Procedures, Male / Q000379:methods* / Q000706:statistics & numerical data; D014572:Urology / Q000706:statistics & numerical data*