Slings in the management of male stress urinary incontinence

Abstract

The available evidence suggests that male slings can be an efficacious and well tolerated treatment modality for men with SUI. Nevertheless, important questions remain with regard to the durability of repair, device safety and comparative efficacy. The mechanism of action and factors that predict failure remain to be fully elucidated.

National study of utilization of male incontinence procedures

“…In our study, patients undergoing sling procedures presented with no infectious complications on the procedure day and a relatively low occurrence of urologic complications, compared to AUS procedures. Indeed, the occurrence of serious complications following sling procedures has rarely been reported by other investigators, except in some specific types of slings, such as adjustable retropubic slings . Further study may be desirable to compare different types of slings and to explore the outcomes and adverse events associated with the different sling procedures.…”

“…Poon et al found incontinence procedures increased over time from 1,936 to 3,366 treatments per year, with bulking agents decreasing from 80% of all incontinence procedures to 60% and AUS use remaining stable, around 12% of procedures. The significant rise in sling procedures can possibly be attributed to the fact that it has an appreciable success rate, costs less and avoids the use of mechanical parts, manual dexterity, and device training . Bulking agents, although the least invasive, were reported to have low success rates and rapid deterioration, and thus were only considered to be beneficial in the short term …”

“…Over time, the adoption of sling procedures has increased considerably . Although the long‐term outcome remains unclear, it is becoming favorable over other invasive treatments due to its less invasiveness, immediate efficacy and low incidence of adverse events …”

A historical perspective and evolution of the treatment of male urinary incontinence

“…As previously described, implantable urethral slings were first introduced by Berry and Kaufman. The frequency of complications such as urethral erosion, fistulas and pain prevented slings from gaining traction early in their development . There were three type of male urethral slings that have been described and used in the past of years: the bone‐anchored, retrourethral transobturator, and adjustable retropubic slings; however, the current most popular form available on the market is the retrourethral transobturator sling.…”

The management of urinary incontinence in the male neurological patient

“…Suburethral slings or tapes become more and more popular for the treatment of male SUI as a minimally invasive option, and different types have been introduced with success rates of 54-80% [80]. In male patients with neurogenic SUI mainly autologous fascia slings, often in combination with bladder augmentation, have been investigated predominantly in pediatric populations but also in adults, demonstrating favorable results and low complication rates [81][82][83].…”