The role of male slings in post prostatectomy incontinence: ICI‐RS 2015

Abstract

It is important to understand how male slings work and by doing so we are more reliably able to choose the appropriate sling, predict outcomes, and as a result counsel patients. Suggestions for future research are proposed.

Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis

“…That could sustain an opinion that ATOMS may be an optimal choice in irradiated patients, also for diminished risk of complications such as urethral atrophy or erosion [15]. However, a recent series with predominance of SSP confirmed that both radiation and SUI severity are independent risk factors for ATOMS failure [12], but these risk factors also determine worse results both for retrobulbar male slings [5, 32] and for AUS [6, 33]. The use of the latest generation device with SSP also reveals better dry rates than reports with devices of predominantly previous generations, but contrary to previous belief [12], not a significant lower risk for complications.…”

“…Further development of adjustable slings with the possibility of postoperative adjustment has widened the spectrum of SUI severity that can be treated with the transobturator perineal approach. Different devices are now available to allow a personalised surgical approach for male SUI [1, 5–7].…”

Patient Selection in Surgical Centers of Expertise in the Treatment of Patients with Moderate to Severe Male Urinary Stress Incontinence

“…Seventy-eight patients (88.6%) that underwent AUS implantation received postoperative antibiotics for a median of 8 days (1-25), and 53 patients (40.2%) that underwent implantation of an adjustable sling received postoperative antibiotics for a median of 5 days (1-20). The median postoperative time until catheter removal was 3 days [2][3][4][5][6][7][8][9][10][11][12][13][14][15] for patients receiving an AUS and 2 days [1][2][3][4][5][6][7][8][9][10][11] for patients receiving an adjustable sling.…”

“…Preoperative patient selection seems to be crucial for a satisfying postoperative result, but guideline recommendations are limited and mainly based on the severity of the incontinence [5]. A current review by Sahai et al [13] evaluating the role of male slings in postprostatectomy incontinence concluded that future research should focus on studies comparing sling systems and the AUS with an evaluation of patient factors such as etiology, severity, or prior surgery. Because of the less-invasive surgical approach without a need to manually operate the device, patients who are given the choice tend to choose a male sling system [9].…”

“…Adjustable male slings are described as an alternative treatment option in male patients with stress urinary incontinence with high patient satisfaction [3, 10]. Their mode of action is a permanent increase in urethral resistance to support basic continence, therefore creating a certain degree of obstruction in contrast to the fixed repositioning male sling system [13].…”