Objective continence measures are central to evaluating outcomes after surgical treatment for male stress urinary incontinence (SUI). However, the extent to which measured urine loss independently predicts patient-reported symptom severity and health-related quality of life remains poorly understood. We aimed to evaluate the association between 1-year pad weight and patient-reported outcomes (ICIQ-SF symptom severity and EQ-5D VAS health-related quality of life) in men with persistent leakage after continence surgery, and to identify independent clinical predictors of these outcomes at 1 year.

This analysis used prospectively collected data from the European Association of Urology Research Foundation multicentre observational SATURN registry enrolling men who underwent surgical treatment for SUI with a male sling, adjustable continence device, or artificial urinary sphincter (AUS). From 1046 registry patients, 285 remained incontinent, and of those, 140 patients with complete 24-hour pad weight data at both baseline and 12 months were included. The primary outcomes were ICIQ-SF total score and EQ-5D Visual Analogue Scale (VAS) at 1 year. Simple linear regression examined the association between 1-year pad weight and each outcome. Multivariable linear regression additionally adjusted for baseline ICIQ-SF or EQ-5D VAS, age, BMI, Charlson Comorbidity Index >=3, oncological versus non-oncological aetiology, complications within year 1, and surgical group (sling, AUS, ProACT).

Of 140 patients, 82 (58.6%) received an AUS, 49 (35.0%) a sling, and 9 (6.4%) ProACT balloon implantation. Median baseline pad weight differed significantly across groups (AUS 628 g vs sling 300 g vs ProACT 231 g). At 1 year, pad weight decreased significantly in all three groups (AUS median 50 g, sling 100 g, ProACT 25 g), with the greatest gram reduction after AUS (median 554 g) compared with sling (155 g) and ProACT (144 g).
Median ICIQ-SF improved from 18 [IQR 16-20] to 10 [8-13] overall. Median EQ-5D VAS improved from 70 [45-80] to 80 [65-85]. In multivariable analysis, 1-year pad weight remained the strongest independent predictor of ICIQ-SF (beta=0.016; p<0.001; n=118; adjusted R²=0.29). Baseline ICIQ-SF was also independently associated (beta=0.268; p=0.042). No other covariate, including surgical group, reached significance. For EQ-5D VAS, 1-year pad weight (beta=-0.027; p=0.015), baseline EQ-5D VAS (beta=0.163; p=0.023), oncological aetiology (beta=+14.92; p=0.007), and complications within year 1 (beta=-13.17; p=0.010) were independent predictors (n=114; adjusted R²=0.15).

Higher residual pad weight at 1 year independently predicts greater symptom burden across all surgical groups. However, leakage weight explains only 6% of variance in EQ-5D VAS, compared with 31% for ICIQ-SF. Surgical group was not an independent predictor of either outcome once baseline leakage was accounted for, suggesting that the superior outcomes observed with AUS reflect the greater degree of leakage reduction rather than a device-specific effect on quality of life. Notably, oncological aetiology predicted better health-related quality of life at 1 year, possibly reflecting psychological adaptation or favourable oncological prognosis. Postoperative complications had the largest negative impact on EQ-5D VAS.

In men with persistent leakage after continence surgery, residual pad weight at 1 year is a significant but incomplete predictor of patient-reported outcomes. While pad weight strongly predicts symptom severity as measured by ICIQ-SF, it explains only a small proportion of variance in health-related quality of life. These findings demonstrate a clinically important dissociation between objective continence and perceived health, and underscore the necessity of not only avoidance of complications but also integrating both dimensions in postoperative evaluation and patient counselling.

Continence 19S (2026) 102514
DOI: 10.1016/j.cont.2026.102514