Male sling procedure

Overview

The male sling procedure is a treatment for men with urinary incontinence, a condition characterized by the inability to control the bladder.

The male sling surgery places a mesh-like synthetic tape around the urethral bulb, gently compressing and repositioning the urethra—the tube that carries urine out of the body—to enhance bladder control and decrease urinary incontinence.

Reasons for undergoing the procedure

The male sling procedure is most effective for men with mild to moderate incontinence, typically using one to three pads per day or fewer.

It is primarily designed to assist men experiencing urinary incontinence following prostate surgery, especially those who have undergone a radical prostatectomy for prostate cancer.

Risk

Similar to any medical procedure, male sling surgery comes with complications, such as:

• Recurring urine leakage
• Difficulty urinating (urine retention), which may need a catheter for a week or two, and in rare cases, another surgery
• Bleeding and infection around the mesh or pubic bone
• Erosion

Before the procedure

Before surgery, certain guidelines may be required, such as: 

• Consume only clear liquids, such as broth or juice, and refrain from eating or drinking anything after midnight, the night before the procedure. If they need to take medication on the morning of surgery, it should be taken with just a small sip of water.
• Avoid aspirin, ibuprofen, and any blood-thinning medications for two weeks, though one can take Tylenol for pain relief.
• Continuing medications, including antibiotics and heart medications, unless instructed otherwise.

Prior the surgery, a preoperative evaluation may be recommended which involves an electrocardiogram (EKG), blood tests, and a urine analysis to ensure overall health before the procedure.

Other tests that may be required include:

• Cystoscopy, an examination of the insides of the bladder
• Urodynamic study, to evaluate how well the urinary system is functioning
• 24-hour pad test, for measurement of urine leakage 

During the procedure

The male sling procedure is primarily used after a radical prostatectomy and is effective in treating mild to moderate urinary incontinence. It involves the following steps:

• Incision is made in the perineal tissue, located between the scrotum and anus.
• The urethra is exposed.
• The surgeon exposes the urethra and places a mesh-like tape around the urethral bulb, which is the upper portion of the urethra near the sphincter.
• To support the bladder neck, the sling slightly realigns the urethra and improves local resistance.

After the procedure

The male sling procedure is typically done on an outpatient basis, though some patients may need to stay overnight in the hospital. One can resume a regular diet immediately after surgery.

After the surgery, a catheter may be inserted into one’s urethra to assist with bladder drainage, as swelling can temporarily hinder urination. As the swelling subsides, one should gradually regain the ability to urinate independently, though it may take a few weeks for normal urination patterns to fully return.

Absorbable stitches are used in the perineum, which can cause mild discomfort, but the pain is generally manageable.

Outcome

The male sling procedure is a minimally invasive surgery that involves a small incision in the perineum, resulting in a brief recovery period. Typically, patients require a catheter for one to three days following the surgery. Many men experience complete resolution or significant improvement in urinary incontinence. For those who continue to experience leakage, an artificial urinary sphincter may be considered, and the healthcare provider will assist in creating a future treatment plan if necessary.