There are several types of a male sling available for men who have prolonged incontinence that is often caused by sphincter damage related to treatment for prostate cancer.
The bulbourethral sling
The bulbourethral sling uses a technique that is similar to slings used to help women with incontinence. The device is:
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):
In another study (Clemens et al):
Tip: Ask the doctor what his or her definition of success or a complete cure is.
Slings 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:
Overall success rates for bone-attached slings have been reported to be between 40% to 88%. Side effects may include:
Adjustable retropubic slings
The benefit of these systems is that they can be adjusted after surgery, making them tighter or looser. One system has a mechanical regulator that is implanted under the skin.
In a European study (Sousa-Escandon, et al) of 51 men who were followed up on average after 32 months:
Another system uses a silicone foam pad that is placed under the bulbar urethra. In a study (Hubner, et al) of 101 men with an average follow up after 2.1 years, 79.2% of men were considered to be dry.
But another study (Dalpiaz, et al) reported mid-term complications after a median follow-up of 35 months that included:
These are often outpatient surgical procedures
Like any surgical procedure, there may be some risks, including:
Before you decide on an approach, it’s important to ask your man'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.
Discuss information from this website with a medical professional
Atiemo HO, Moy L, Vasavada S, Rackley R. Evaluating and managing urinary incontinence after prostatectomy: beyond pads and diapers. Cleveland Clinical Journal of Medicine. 2007;74 (1):57-63.
Clemens JQ, Bushman W, Schaeffer AJ. Questionnaire based results of the bulbourethral sling procedure. J Urol. 1999;162:1972-1976.
Comiter CV. The male perineal sling: intermediate-term results. Neurourol Urodyn. 2005;24:648-653.
Kim JC, Cho KJ. Current trends in the management of post-prostatectomy incontinence. Korean J Urol. 2012;53(8):511-518.
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.