New perineal bone-anchored male sling: lessons learned

To identify factors affecting outcome after the male sling procedure for stress urinary incontinence.

A total of 46 incontinent men, with a mean age of 67 years, underwent perineal bone-anchored male sling placement. Three titanium bone screws with preattached pairs of No. 1 polypropylene sutures were placed directly into the medial aspect of each inferior ramus of the pubic bone. To compress the urethra, three different types of materials were used: absorbable biomaterial, silicone-coated polypropylene mesh, or a composite graft. Patient characteristics, incontinence etiology and severity before surgery, prior collagen injections, and type of material used were assessed, and the association with the outcome of the male sling procedure was determined.

The procedure was successful in 35 (76%) of 46 patients at a mean follow-up of 18 months (range 6 to 30). Nineteen patients were totally dry and 16 had improved 50% or more compared with before surgery. Failure occurred in 11 patients (24%). Patients who received a composite graft or mesh alone had a better outcome compared with the absorbable sling group (97% and 75% versus 0%, respectively, P = 0.001). The severity of pretreatment incontinence also had a negative impact on the outcome.

Patients with mild-to-moderate incontinence and the use of a composite graft had the best outcomes after the perineal bone-anchored male sling.