The male sling implantation for urinary incontinence after prostate surgery: a real-world multi-center study in China

Urinary incontinence after prostate treatment (IPT) is a distressing phenomenon. The aim of this real-world study was to evaluate the efficacy of the male sling in treating IPT in China.

A total of 66 patients (83.8% with moderate and severe urinary incontinence) with IPT underwent male sling implantation in four medical centers. Incontinence was assessed using pad weight, pad usage per day (PPD), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Surgical efficacy, surgical modalities, BMI, and complications were evaluated.

Median follow-up was 23 months. Of 66 patients with transobturator (2-arm) and transobturator and anterior pubic (4-arm), 16 (24.2%) were cured, 40 (60.6%) improved, and 10 (15.1%) failed according to PPD. In terms of 24-h pad weights, 16 (24.2%) and 24 (36.3%) achieved continence (dry pad) or mild incontinence (< 100 mL/day); 22 (33.3%) and 4 (6%) were still with moderate (100-400 mL/day) or severe (> 400 mL/day) incontinence. Four (100.0%) patients preoperatively with mild incontinence were not cured, but all improved in terms of PPD. Of 39 patients preoperatively with moderate incontinence, 9 (23.1%) were cured, 24 (61.5%) improved, and 6 (35.8%) failed. Of 23 patients preoperatively with severe incontinence, 7 (30.4%) were cured, 12 (52.1%) improved, and 4 (17.4%) failed. The improvement rate for patients with three different levels of incontinence was 100%, 84.6%, and 82.6%, respectively. There was no significant correlation between the degree of recovery and BMI. Common postoperative complications include pain, incision infection, foreign body sensation, and urinary retention or dysuria.

The majority of patients receiving male urethral sling implantation are moderate and severe patients. Real-world studies show that male urethral suspension is more often used to treat male urinary incontinence than AUS in China, and medical insurance policies and economic costs are important influencing factors. The utilization of this intervention has yielded a considerable rate of amelioration for IPT. It must also be admitted that comparative analysis indicates that male slings confer a superior overall prognostic improvement for patients presenting with mild urinary incontinence relative to those with moderate and severe manifestations of the condition, especially for severe urinary incontinence has improved, but a large proportion of patients still have symptoms.