The male sling procedure was developed to help men with urinary
incontinence due to sphincter weakness or insufficiency in the setting of prior
pelvic surgery including post-TURP (transurethral resection of the prostate) and
post-radical prostatectomy. The procedure is proving that this option is
probably most satisfactory for men with mild-to-moderate urinary incontinence (2
to 3 pads per day or less). One of the distinct advantages of the male sling is
that it can be performed with a fairly short recovery and requires only a small
incision in the groin (between scrotum base and the anus). The procedure itself
entails placement of a synthetic mesh in the groin area to compress the urethra
under it. Most patients have their catheters stay in overnight and can be
removed in the hospital in the case of an overnight (23 hour) stay or in the office the next day.
What does the surgery entail?
Prior to surgery, your physician may ask you to have a
urodynamic study (testing to assess urinary tract function), complete a 24-hour
pad test (to identify the number of pads used and volume of urine leaked), or
look inside your bladder (cystoscopy).
The male sling procedure is usually performed on an outpatient
basis, however, in some cases, patients are kept in the hospital or surgicenter
unit for 23 hours. The sling support or suspension requires permanent sutures in
the perineum and may create some pain in the immediate post-operative period.
Incisions are made through the perineal tissue (ie, the urogenital area) to
reach the surgical target -- the positioning of a supportive sling (a mesh-like
surgical tape) around part of the urethral bulb (the descending tube-like
structure of the bladder). By wrapping the surgical tape around the urethral
bulb, the sling gently and slightly moves the urethra into a new position that
has been shown in and of itself as a method of overcoming urinary incontinence.
(Figure: In the male sling procedure, synthetic mesh-like surgical tape is positioned around part of the urethral bulb, slightly compressing the urethra and moving it into a new
position. This action in and of itself has been shown to overcome the problem of
urinary incontinence in many patients.)
Some patients undergoing the procedure have been cured of their
urinary incontinence; others have improved (decreasing their daily pad usage).
What are the risks and complications of the male sling procedure?
Complications of this type of procedure are rare but may occur. They include bleeding and infection (of the mesh or the bone area or public bone), erosion, inability to urinate (retension of urine -- very rare) or recurrent leakage. We do not require routine blood donation before surgery.