Male Stress Urinary Incontinence (SUI)
Male SUI sling surgical technique will involve urethra compression by the sling, and/or sling preventing of urethral hyper-mobility (excessive downward movement of the urethra).
The causes for SUI
Male Stress Urinary Incontinence occurs when the sphincters surrounding the urethraopen at an inappropriate time - laugh, sneeze, cough, lift something, or change posture.
Despite advances in surgical technique and the recent advent of laparoscopy and robotic assistance, urinary incontinence remains a real and potential problem for patients after radical prostatectomy. However, in today's clinical practice, such patients more typically present with mild to moderate degrees of urinary leakage.
Surgery to treat BPH or prostate cancer, radiation therapy, or removal of the prostate.
The percentage of patients undergoing surgical prostate removal who have incontinence can vary from 2- 20%, depending on how the studies define and report incontinence. Overall, roughly 8% of all open radical prostatectomy patients are permanently incontinent. The older the patient, the more likely he is to become incontinent following surgery and to never regain urine control. After prostate surgery, urine control for most men improves with time, with the most significant improvement occurring in the first 3 months. Seventy-one percent of patients leak less than one pad per day by 3 months, and 87% of men leak less than one pad per day by 6 months.
In other words, significant and gradual return of urine control levels off after 6 months post-surgery. Therefore, any stress incontinence surgery is not considered until 6 months post-prostatectomy
Male SUI surgical techniques include:
Bone-anchored slings result in compression to the bulbar urethra through placement of a synthetic or organic mesh which is secured to the inferior pubic ramus using six titanium screws. Sutures are subsequently secured to the screws and mesh material and tightened to result in appropriate tensioning.
In contrast to the Bone Anchored Slings which utilizes anchored sutures, the retrourethral transobturator slings is self-anchored with bilateral polypropylene mesh arms placed in a transobturator fashion. The sling portion is secured at the proximal bulbar urethra with continence achieved through subsequent elevation of the urethra.
Adjustable Retropubic slings are surgically placed at the proximal bulbar urethra, with traction sutures placed retropubically. The sutures are then tensioned at the level of the rectus fascia utilizing either a “veritensor” device or silicone columns and washers to provide an appropriate level of urethral compression.
A fourth category of sling which has recently been introduced is the quadratic sling. The sling consists of a broad-based mesh material placed over the bulbar urethra similar to the BAS. It is then self-secured with four mesh arms which are placed in both a transobturator (two arms) and prepubic (two arms) manner.