The male perineal sling: assessment and prediction of outcome

The male perineal sling has become an option for treating male stress incontinence. We evaluated its overall efficacy and determined preoperative parameters that could predict success.

A total of 62 men with stress incontinence were prospectively evaluated and underwent a male perineal sling. Preoperatively 24-hour pad weight, urodynamics and a number of validated incontinence questionnaires were completed. At a minimum of 3 months of followup 24-hour pad weight and questionnaires were repeated. Success was assessed using the 1 question Patient Global Impression of Improvement. The Patient Global Impression of Improvement was compared to a number of other subjective and objective measures of outcome. Finally, preoperative parameters were evaluated to determine predictors of outcome.

As determined by the Patient Global Impression of Improvement, the success rate was 58%. The only preoperative factor predictive of success was 24-hour pad weight. An individual had a 71% chance of successful surgery if preoperative pad weight was less than 423 gm. There was a statistically significant difference between successes and failures in terms of postoperative pad weight and certain questionnaires, including the UCLA/RAND Prostate Cancer Index urinary function score, International Consultation on Incontinence short form, Incontinence Impact Questionnaire, Urogenital Distress Index and International Prostate Symptom Score. The overall complication rate was 21% and the reoperation rate was 14.5%.

The male perineal sling can be an effective surgical treatment for stress incontinence in the appropriate patient. The procedure is most successful in patients with lesser objective degrees of incontinence. The Patient Global Impression of Improvement is an effective tool for assessing outcome for this population.