Male sling for bladder incontinence

An option for some men

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.

There are different devices, but they all require some kind of surgery.

The bulbourethral sling

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
  • Surgically implanted through the abdomen (often using laparoscopic surgery) underneath the urethra inside the man’s body
  • 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.

Tip: Ask the doctor what his or her definition of success or a complete cure is.

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 in 17 men (which requires another surgery)
  • A small number of men (6%) had urinary tract erosion
  • 3% of men had infection

In another study (Clemens et al):

  • Only one of 12 men who had adjuvant radiation (radiation in addition to another type of treatment, such as surgery), had success with the bulbourethral sling
  • 32 men reported persistent numbness or discomfort

Male 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
  • 31 men needed no pads, 7 men needed 1 pad a day, and 3 men needed 2 pads a day
  • 7 men failed and needed more than 3 pads a day

Overall success rates for bone-attached slings have been reported to be between 40% to 88%.  Side effects may include:

  • Acute urinary retention
  • Infection of the perineal incision
  • Erosion of the urethra
  • Pain
  • Urinary urgency
  • Loosening of the bone screws

Adjustable retropubic slings

The benefit of these systems is that they can be adjusted after surgery to make 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 on average after 32 months:

  • 33 men (64.7%) were considered to be cured and 25 of these men did not have to wear pads
  • The other men needed only small pads or sanitary napkins

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, including:

  • Acute urinary retention
  • Removal of the sling
  • Persistent pain

Side effects

Like any outpatient surgical procedure, there may be some risks, including:

  • Complications from anesthesia
  • Heart attack
  • Stroke
  • Blood clots
  • Infection

Before you decide on an approach, it’s important to ask the 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.

Always consult a medical professional.

Updated 3/15

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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.

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