Slings in iatrogenic male incontinence: Current status

Abstract

Objectives:The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence.Materials and Methods:MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated.Results:With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively.Conclusions:Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.

Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence

“…The main and more prevalent cause of PPUI is radical prostatectomy (RP), and its incidence varies from 2.5% to 67% ( 5 , 6 ).…”

Potential risk factors and outcomes of artificial urinary sphincter placement after radical cystectomy and orthotopic neobladder urinary diversion

“…QoL after cystectomy has been directly linked with the patient's return to continence after RC 1, 2. There is limited success managing these patients with biofeedback, behavioral modification, endoscopic collagen injections, and urethral slings 5–7…”

Stem Cell Therapy for Male Urinary Incontinence

“…Injectable bulking agents are minimally invasive but have a poor long-term efficacy [11,12]. More invasive approaches, like sling procedures or artificial urinary sphincter implantation, are more effective but have a higher morbidity [13,14,15]. In this setting, there is an increasing need for minimally invasive and effective approaches with low morbidity for the treatment of SUI.…”