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Male slings for incontinence

This relatively new technique uses a special plastic mesh to help support and reposition the urethra near the area of the urinary sphincter. Although Male Sling procedures have been done in the UK for 10 years, we still don't have many studies that show how well they work in the long-term, or how well they work for men with more severe levels of incontinence.
 

How is a male sling operation performed?

A cut is made just behind the scrotum and a tape made out of a synthetic mesh material is placed under the water-pipe (urethra). The tape pulls the water-pipe upwards and supports it so that urine leakage is prevented.

The operation does not require major surgery and the recovery time is usually very quick. You will probably stay in hospital for one night. We always advise strict rest for 6 weeks afterwards with no heavy lifting or exertion to let the tape get firmly attached. The success rate for this procedure is good and 70% of men only need one small pad per day or less afterwards. ABout 50% are completely dry. A Male Sling operation may not be right for all patients; patients having this procedure should ideally have the following:

  1. Stress incontinence following radical prostatectomy operation
  2. Failure to improve with initial therapy (ie pelvic floor exercises for 6-12 months)
  3. Incontinence requiring 1 to 3 pads per day
  4. No overnight incontinence
  5. No radiotherapy treatment

Afterwards, there can be bruising and discomfort. There is a risk of difficulty passing urine afterwards. This may require a catheter to be left inside for a few days but it is usually only temporary.  Other rarer complications include the possibility of damaging the water-pipe (urethra) or small nerves and blood-vessels during the procedure. In the long-term there is a small risk of damage to the water-pipe (urethra) caused by the mesh.

The main alternative operation is an Artificial Urinary Sphincter (AUS). This is a slightly more complex operation, but the AUS is very effective even in severe cases of incontinence and your doctor will discuss which procedure is likely to be best for you.

 

What are the results after a male sling procedure?

70% of men with incontinence requiring 1-3 pads per day will find their continence is either improved or cured after this procedure. About 50% will be completely dry.
 
Being a relatively new procedure, we don't know how effective this treatment is after many years, but early results are very promising and it is likely that the beneficial effects will not be lost over time. The main risks of the procedure include failure to fully correct the incontinence (especially for more severe or heavy leakage) and a risk of the mesh eroding into the urethra (but this is rare).
 

After the operation

You will be up and around almost straight away but it is important to take things easy for at least 6 weeks afterwards to let the sling heal fully. You will need to avoid any heavy lifting, exercises or straining during this period.
 
One of the most promising sling systems is the AdVance system made by Boston Scientific.
 
For more information, follow this link to the BAUS patient information leaflet on Male Sling.