Post prostatectomy stress urinary incontinence can significantly impact on quality of life and is bothersome for patients. The artificial urinary sphincter is still considered the gold standard surgical treatment. Male slings are an alternative surgical option and several designs are currently available. This review will focus on efficacy, adverse events, and mechanism of action of male slings. The context of this review was a proposal at the ICI-RS meeting 2015. Following synthesis of the evidence we address the question: does it matter how male slings work?
The proposal lecture was reviewed and a comprehensive review of the literature undertaken utilising the PubMed database.
Male slings can be broadly divided into adjustable retropubic and suburethral transobturator slings. Male slings are efficacious and can improve quality of life. Adjustable retropubic slings appear to be compressive but studies suggest efficacy can be achieved without voiding dysfunction. Transobturator slings work by urethral compression and/or re-locating the urethral bulb. There is a recognized failure rate in all sling types and most studies suggest radiotherapy as a risk factor for failure. Adjustable slings have the ability to be altered to optimize continence or to prevent retention of urine. However, there appears to be a higher explantation rate in some of these systems.
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.
Neurourology and urodynamics. 2017 Apr [Epub]
Arun Sahai, Paul Abrams, Roger Dmochowski, Ralf Anding
Department of Urology, Guy's Hospital, Kings College London, London, UK., Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK., Department of Urologic Surgery, Medical Center North, Vanderbilt University Medical Center, Nashville, Tennessee., Department of Neuro-Urology, University Hospital, Bonn, Germany.