Trifecta outcomes in surgical treatment of male stress urinary incontinence

Abstract

Introduction and objective

Stress urinary incontinence (SUI) remains a significant challenge in male patients, particularly following prostate surgery. Despite advancements in surgical techniques and technologies, a standardized method for evaluating treatment success remains under discussion. This study aims to propose a conceptual and comprehensive model that incorporates three key outcomes: quality of life, urinary leakage control, and safety, to provide a structured approach to the assessment of surgical interventions for SUI.

Evidence acquisition

A literature review was conducted, focusing on clinical guidelines and outcome measures used in studies of SUI treatment. Key parameters were selected based on their relevance to patient satisfaction, clinical practice, and international standards, including the International Continence Society (ICS) and patient-reported outcomes (PROs).

Results

The proposed trifecta model includes three essential criteria: (1) Quality of life, assessed by the Visual Numeric Scale (VNS) with scores of 0–2 indicating significant improvement; (2) Urinary leakage control, defined as “social continence” (use of 0–1 pad per day), reflecting practical success; and (3) Safety, evaluated by the absence of complications within 90 days postoperatively, aligning with standard follow-up timelines. This model addresses both objective and subjective outcomes. While it does not encompass long-term results, the trifecta is adaptable for extended evaluations at 1, 5, and 10 years and serves as a conceptual framework requiring future clinical validation.

Conclusion

The proposed trifecta model suggests a patient-centered framework to evaluate the outcomes of surgical interventions for SUI. By addressing critical domains, it offers a structured method for clinical and research assessment. However, its clinical applicability requires confirmation through prospective validation in diverse patient cohorts.