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

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. • To examine the outcomes and adverse events associated with novel male sling designs described in the last decade. METHODS• A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database. RESULTS• Three 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. CONCLUSIONS• Most male slings have a similar reported effi cacy. Most case series defi ne 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 defi ne criteria for the use of male slings, and to directly compare different procedures.INTRODUCTION Prostate cancer is the most common solid organ cancer in men. It accounts for 22 -28% of all male cancers, and > 500 000 men are diagnosed a year in the USA and Europe [ 1,2 ] . Mortality rates are estimated at ≈ 10%, and are slowly declining [ 1,2 ] . The improving mortality rates are contrasted by the continued long-term morbidity related to prostate cancer treatment.

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

“…Acute urinary retention occurs in 3% to 21%, and was the most common complication seen in our series (18.4%). 25 Causes of retention include perineal pain, urethral manipulation, urethral compression and postoperative swelling. 25 To date, only 5 severe complications (persistent retention, wound infection, osteitis pubis, sling placed through urethra and urethral erosion) requiring removal or revision have been reported.…”

“…25 Causes of retention include perineal pain, urethral manipulation, urethral compression and postoperative swelling. 25 To date, only 5 severe complications (persistent retention, wound infection, osteitis pubis, sling placed through urethra and urethral erosion) requiring removal or revision have been reported. [26][27][28] The limitations of this study include its retrospective nature, lack of exact pad weights, heterogeneous followup, and lack of standardized quality of life improvement questionnaire.…”

Management of incontinence after prostate surgery

“…Serious complications are unusual. 10 There are, however, limited longterm outcome data for male slings and currently their use in the UK is limited to clinical trials or following informed consent regarding the lack of follow-up data. Figure 1).…”

Update on management of post-prostatectomy incontinence in 2013

“…1). 2 The most common reported adverse events are retention (0-12%), infection (2-12%) and perineal/scrotal pain.…”

“…1). 2 The most common reported adverse events are retention (0-12%), infection (2-12%) and perineal/scrotal pain.While many individuals will experience treatment success with InVance sling insertion, it should be noted that there is still a sizable proportion of patients for whom this surgery will fail. In one of the studies, for example, patient perception of their status post-insertion was rated as "very much better" by 37%, "much better" by 21%, but was considered to have failed by 42% of patients.…”