Slings for Male Incontinence

Excerpt

Male stress urinary incontinence (SUI) is the unintentional release of urine during activities characterized by an increase in intraabdominal pressure that significantly impacts life quality. Symptoms of male SUI vary from sporadic leakage of small amounts of urine to complete loss of bladder control. The most common causes of male SUI are radical prostatectomy and neurological disease.

Approximately 5% to 10% of men 65 years and older experience some form of urinary incontinence, and as many as 60% of men experience some degree of urinary incontinence following prostatectomy. The initial treatment of male SUI comprises lifestyle modifications, pelvic floor physical therapy, bladder retraining, and medications; surgical options such as urethral slings are considered only when conservative management proves ineffective.

A male sling is a synthetic strip positioned beneath the anterior bulbous urethra to facilitate urethral coaptation and reduce or prevent leakage. The modern male sling was introduced in the 1990s as a minimally invasive surgical alternative to artificial urinary sphincters (AUS). The management of male SUI is a constantly evolving field, and several adjustable and nonadjustable slings are currently available for widespread use.

This activity reviews the indications for and contraindications to male sling placement and the required equipment, personnel, and techniques to complete such a procedure. The activity also reviews the identification, evaluation, and management of the most frequent complications of male sling placement and highlights the role of the interprofessional team in improving outcomes for men with SUI.