Introduction: Male urethral slings are an accepted procedure for the patient with mild to moderate stress urinary incontinence (SUI). The success and dry rates previously reported in the literature ranges from 73 to 89.4% and 51 to 77% respectively. However, little information is known about medium to long term outcome in particular further surgical intervention and failure.
To determine surgical re-intervention rates following Male Sling in the medium to long term and assess the success rate and dry rate in accordance with the preoperative SUI severity.
Methods: A retrospective analysis of a cohort undergoing male sling (Advance, Boston Scientific) by two surgeons at a single centre between 2009 to 2018 was carried out. Data collected included patient demographics, pre and post-operative International Consultation on Continence Questionnaire – Short Form (ICIQ-SF) scores, and pad use per day. Further surgical intervention (Artificial Urinary Sphincter (AUS)) either performed or offered considered as intervention rate, success rate defined as improvement of symptoms >50% (ICIQ-SF and Pad numbers), dry rate measured as zero pad or occasional leakage. Preoperative severity was categorized as mild SUI (1 to 2 pads /day), moderate SUI (3 to 4 pads/day) or severe SUI (5 or more pads/day).
Results: A total of 91 patients with median age of 71 years (range 56 to 80 years) underwent sling insertion with median follow up 66 months (ranges from 12 months to 125 months). Success rate in mild SUI, moderate SUI and severe SUI groups were 87.5% (28 out of 32 patients), 80% (36 out of 45 patients) and 57.1% (8 out of 14 patients) respectively. The dry rate in the mild SUI cohort was 81.2%(26 out of 32 patients), 71.1% (32 out of 45 patients) in the moderate SUI cohort and 42.9% ( 6 out of 14 patients) in the severe SUI cohort . The re-intervention rate noted in mild SUI chort was 6.3% (2 out of 32 patients), 17.8% (8 out of 45 patients) in the moderate SUI cohort and 42.8% (6 out of 14 patients) in the severe SUI cohort. The overall success rate in all patients were 79.1% (72 out of 91 patients), dry rate 70.3% ( 64 out of 91 patients) and re-intervention rate 17.6% (16 out of 91 patients)
Conclusions: The Male sling medium to long term outcomes are good and the need for further surgical re-intervention is acceptable with approximately 1 in 6 requiring further surgery. However with careful patient selection with mild to moderate incontinence the re-intervention rate is 1 in 10 in the medium to long term. Source of
