The male sling for SUI: Indications and techniques

December 1, 2006

The male sling achieves continence by unilateral ventral urethral compression that does not require patient activation, allowing volitional and spontaneous voiding.

Advantages of the perineal sling

Unique to the perineal sling is the use of titanium bone screws and the low risk of associated osteitis pubis or osteomyelitis. In our experience, which is supported by reports in recent literature, patients who have undergone placement of this sling have not experienced either osteitis pubis or osteomyelitis (J Urol 2002; 167:597-601).

Patient selection

Candidates for the male sling (InVance, American Medical Systems) are those men who suffer from mild to moderate stress urinary incontinence. The majority of men will have undergone a radical retropubic prostatectomy, but other etiologies of male stress incontinence can include a perineal prostatectomy, open prostatectomy, transurethral prostate surgery, or mild neurologic external sphincter weakness.

It is essential to confirm preoperatively that stress incontinence is the etiology of the patient's incontinence. After a complete history and physical examination, we perform both a cystourethroscopy to detect anatomic obstruction, such as a urethral stricture or bladder neck contracture, and video urodynamics to evaluate bladder filling, storage, and emptying.