“AdVance” Male Sling Patient Information
Why do I need a Male Sling?
The urethral sphincter is the muscle which holds the urine in the bladder until you are ready to go. If the sphincter muscle is damaged or weakened (eg by surgery) then urine may leak out.
It is quite common to become incontinent after undergoing prostate surgery for prostate cancer (radical prostatectomy). Pelvic muscle exercises can often help this to recover, but if it doesn’t settle then operations may be suggested.
What is a Male Sling?
A Male Sling is a ribbon of mesh made out of a plastic material. It is placed under the urethra (water passage) in the area close to where the prostate was removed. The sling pulls the water-pipe upwards and supports it so that urine leakage is prevented.
An incision is made in the perineum (behind the scrotum) and the urethra is located. The urethra is freed up and central part of the sling is sutured to the urethra. The sling has two side arms which pass around the side of the pelvis on each side and hold the sling in place. These arms are also made of mesh.
The operation does not require major surgery and the recovery time is usually very quick. You will probably stay in hospital for one night.
Is this procedure right for me?
The Male Sling procedure has not been around for as long as other operations such as the Artificial Sphincter operation and so we don’t have as much information about results in the long term (eg more than 5 years). The success rate for this procedure is good (70-80%) but it may not be right for all patients. Patients having this procedure should ideally have the following:
- Stress incontinence following radical prostatectomy operation
- Failure to improve with pelvic floor exercises (for 6-12 months)
- Incontinence requiring 1 to 3 pads per day
- No overnight incontinence
- No radiotherapy treatment
The main alternative operation is an Artificial Urinary Sphincter (AUS). This is a slightly bigger operation. However, the AUS is very effective even in severe cases of incontinence and your doctor will discuss which procedure is likely to be best for you.
What are the results after a Male Sling procedure?
70-80% of men with incontinence requiring 1-3 pads per day will find their continence is either improved or cured after this procedure.
Being a relatively new procedure, we don't know how effective this treatment is after many years, but early results are very promising and it is likely that the beneficial effects will not be lost over time. The main risks of the procedure include failure to fully correct the incontinence (especially for more severe or heavy leakage) and a risk of the mesh eroding into the urethra (but this is rare).
Are there any side-effects?
Common (greater than 1 in 10)
- Blood in the urine , and temporary stinging when you urinate after the procedure
Occasional (between 1 in 10 and 1 in 50)
- Urine infection
- Wound infection
- Temporary insertion of a bladder catheter
- Recurrence of the incontinence
- Haematoma / bruising around the wound
Rare (less than 1 in 50)
- Erosion of the sling through the waterpipe (urethra)
What should I expect when I get home?
After the operation there can be bruising and discomfort. There is a risk of difficulty passing urine afterwards. This may require a catheter to be left inside for a few days but it is usually only temporary.
You should take things easy, especially for the first two weeks. Heavy lifting or exertion may cause bruising and swelling and slow you recovery. After two weeks, you can resume most normal activities, but strenuous exertion is not advised.
Cycling, horse-riding and other activities which cause extra pressure on the perineal wound (between the anus and scrotum) should be avoided. Sexual intercourse can be resumed after you have been reviewed in clinic.
Antibiotics will be provided for a few days after the operation as a routine precaution. Simple painkillers will also be provided, and laxatives should be used if you are constipated.
It is important to keep your wounds clean and dry. You should wash daily and pat the wounds dry with a clean towel afterwards. We advise you do not take a bath for 2 weeks after your surgery but you may shower 48 hours after surgery.