Male sling for bladder incontinence

Now there is a male sling available for men who have prolonged incontinence that is often caused by sphincter damage related to treatment for prostate cancer.

There two types of procedures for implanting a male sling

The first type—called the bulbourethral sling—uses a technique that is similar to slings used to help women with incontinence. The device is typically made of a synthetic mesh material and is surgically implanted through the abdomen (often using laparoscopic surgery) underneath the urethra inside the man’s body. It is then tied to the fibrous tissue of the rectum to keep it in place.

The male sling supports the urethra, which is the tube that carries urine from the bladder through the penis (where it is released when a man urinates). The sling also helps return the urethra to its normal position to help reduce the risk of urine leakage, particularly when a man coughs, sneezes, or engages in strenuous activities.

In one study (Schaeffer et al) of 64 men with severe incontinence following prostatectomy (50% of the men were totally incontinent), 36 men were dry about a year and a half after getting a bulbourethral sling. Slings needed to be retightened (which requires another surgery) in 17 men. A small number of men (6%) had urinary tract erosion, and 3% of men had infection.

In another study (Clemens et al), only one of 12 men who had adjuvant radiation therapy (radiation in addition to another type of treatment, such as surgery), had success with the bulbourethral sling. In this same study, 32 men reported persistent numbness or discomfort.

Sling attached to the bone

Another procedure attaches the male sling to the pubic bone on both sides of the urethra (usually with titanium screws). The male sling places pressure/constricts the urethra, which prevents it from releasing urine.

In one study (Comiter et al) of 48 men who used at least 3 pads a day for stress bladder incontinence after radical prostatectomy, average pad use decreased to about one pad a day, two to four years after receiving the bone-attached sling. Thirty-one men needed no pads, 7 needed 1 pad a day, and 3 needed 2 pads a day. Seven men failed and needed more than 3 pads a day.

These are often outpatient surgical procedures

Like any surgical procedure, however, there may be some risks, including complications from anesthesia, heart attack, stroke, blood clots, and infection. Before you decide on either approach, it’s important to ask your loved one’s doctor about all the benefits and associated risks.

Your loved one may need a catheter for a day or so. While recovery time is expected to be fairly quick, he may be advised to avoid heavy lifting or activities that could result in straining for several months.

Updated 11/10

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Schaeffer AJ, Clemens JQ, Ferrari M, Stamey TA. The male bulbourethral sling procedure for post-radical prostatectomy incontinence. J Urol. 1998;159(5):1510-1515.