The male sling for stress urinary incontinence: A prospective study

Purpose: This is a report of a prospective study of the male sling for treating stress urinary incontinence. Materials and Methods: A total of 21 men underwent sling surgery. There were 2 titanium screws loaded with polypropylene suture placed in each descending pubic ramus through a 3.5 cm. perineal incision at the level of the bulbar urethra. A polypropylene mesh was placed over the urethra and tied to the bone anchors, adjusting sling tension to a compression pressure of 60 cm. water. Followup was done with the incontinence section of the University of California, Los Angeles/RAND Prostate Cancer Index. Results: Mean followup was 12 months (range 5 to 21). Overall, incontinence was cured in 16 (76%) patients, substantially improved (stress urinary incontinence very small or small problem, 1 pad daily) in 3 (14%), somewhat improved (moderate problem-2 pads) in 1 and procedure failed (no improvement) in 1 (5%). The patients with stress urinary incontinence after undergoing transurethral prostatectomy were cured, as was the individual with myelomeningocele. Of the 18 patients with stress urinary incontinence after radical prostatectomy 13 were cured, including 1 of 2 who underwent previous artificial urinary sphincter placement and 2 of 3 adjuvant radiation. There was significant improvement in each survey question, and the total score improved from a mean plus or minus standard deviation of 65 +/- 11 preoperatively to 397 +/- 29 postoperatively (p < 0.001). There was no retention, infection, erosion or de novo voiding dysfunction. Conclusions: This minimally invasive sling surgery has not been associated with any significant complication, and early results compare favorably with artificial urinary sphincter. By compressing only the ventral urethra the risk of urethral erosion and atrophy is reduced. Prior radiation or artificial urinary sphincter does not appear to be a contraindication to sling surgery.