The male perineal sling: intermediate-term results

Area of Science:

• Urology
• Surgical Innovation
• Men's Health

Background:

• Stress urinary incontinence (SUI) in men, often due to sphincteric incompetence, presents several surgical treatment options.
• Existing options include periurethral bulking agents, artificial urinary sphincter (AUS) implantation, and sling surgery.
• The male sling has shown favorable short-term outcomes, necessitating evaluation of its intermediate-term efficacy.

Purpose of the Study:

• To evaluate the intermediate-term results of the bone-anchored male perineal sling for treating SUI in men.
• To assess the efficacy and safety of this surgical technique with a median follow-up of 4 years.

Main Methods:

• A cohort of 48 male patients (average age 68 years) underwent bone-anchored male perineal sling surgery between March 2000 and April 2003.
• Pre-operative and post-operative evaluations included patient history, physical examination, pad score, and the incontinence section of the UCLA/RAND prostate cancer index (PCI).
• Follow-up ranged from a minimum of 2 years to a median of 4 years.

Main Results:

• All patients initially reported severe incontinence, using 3 or more pads daily.
• Post-operatively, average pad usage decreased significantly from 4.6 to 1.0 pads per day (P < 0.01).
• 65% of patients were cured (0 pads), 15% significantly improved (1 pad), 6% mildly improved (2 pads), and 15% failed (>3 pads).

Conclusions:

• The bone-anchored male perineal sling demonstrates intermediate-term success rates comparable to artificial urinary sphincter (AUS) surgery, with 80% of patients using 1 pad or less daily.
• This surgical technique is associated with very low morbidity.
• It represents a reliable alternative to AUS surgery for the management of male SUI.