The male sling for post-prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes


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Abstract

What's known on the subject? and What does the study add?Long-term cure and improved rates for the bone anchored sling range from 40–88%. Midterm cure and improved rates for the retrourethral transobturator sling rage from 76–91%. Midterm cure and improved rates for the adjustable retropubic sling rage from 72–79%.Potential complications common to all urethral slings include postoperative urinary retention, perineal pain, and urethral erosion/device infection. All male urethral slings have primarily been studied in post radical prostatectomy patients, with inconsistent success among patients with prior pelvic radiation.OBJECTIVETo examine the outcomes and adverse events associated with novel male sling designs described in the last decade.METHODSA literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database.RESULTSThree principal slings are described in the literature. The bone-anchored sling has success rates of 40–88%, with some series having a mean follow-up of 36–48 months. It is associated with a mesh infection rate of 2–12%, which usually requires sling explantation.The retrourethral transobturator sling has a success rate of 76–91% among three large case series with follow-ups of 12–27 months. There is a low reported explantation rate.The adjustable retropubic sling has a success rate of 72–79% with follow-ups of 26–45 months. Erosion (3–13%) and infection (3–11%) can lead to explantation.CONCLUSIONSMost male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid- and long-term data are now available that indicate the male sling is a viable option for PPI.The use of male slings in severe UI, radiated patients, and non-radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.

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