Male Sling Urology

What is Stress Urinary Incontinence?

Stress urinary incontinence is the leakage of urine with exercise or exertion that increases intraabdominal pressure, e.g. coughing, sneezing, laughing. It may occur in men after a radical prostatectomy (surgery for removal of the prostate) or radiation therapy to the prostate. It can also occur after trauma to the pelvic floor muscles.

What is a male sling?

A male sling consists of a synthetic mesh-like surgical tape. The urethra is a pipe through which urine leaves the body. The male sling is positioned around the urethral bulb, slightly compressing and moving the urethra into a new position. This supports your pelvic floor muscles and increases resistance to the pressure of a full bladder thereby reducing urinary leakage.

Who is suitable for a male sling?

The male sling helps men with stress incontinence. You may consider it if you experience mild to moderate stress incontinence (wetting one to three pads a day). If you have had radiotherapy, outcomes may be less effective, with a higher complication rate.

How is the surgery performed?

The surgery is performed under General or Spinal Anaesthesia. An incision is made through the perineum (the area between the scrotum and anus) and small incisions made in both thighs. The surgeon will expose the urethra and place the male sling around part of the urethral bulb. Absorbable sutures will be used for wound closure.

Figure 1. Two-arm sling Source: EAU Patient Information

What tests may be done prior to the procedure?

• Urodynamic study to evaluate your urinary tract function

• 24-hour pad test to identify number of pads utilised and amount of urine leaked

• Cystoscopy to evaluate your bladder

• Pre-operative investigations (blood tests, ECG, chest x-ray) depending on your Anaesthetist’s assessment

Are there any risks involved? Complications are not commonly seen but the procedure carries risks of:

• Bleeding or bruising around scrotum

• Pain or discomfort around wound incisions, which is usually temporary

• Burning or stinging sensation during urination

• Difficulty with urination, which may require insertion of a urinary catheter

• Wound infection which may require sling removal

• Damage to the urethra during the procedure – we will not proceed with mesh insertion if this occurs

• Injury to the bladder or urethra which requires a prolonged period of catheterisation

• Groin pain and discomfort –may last several months or be permanent

• Erosion of the male sling

What are the alternatives?

• Continence aids e.g. pads; penile clamps to reduce urinary leakage

• Pelvic floor exercises to strengthen pelvic floor and reduce urinary leakage

• Insertion of an Artificial Urinary Sphincter (AUS), a small device placed within the body to maintain urinary continence. A pump in the scrotum needs to be gently pressed to allow passage of urine

• Long-term urinary catheter –urinary or suprapubic

• Urinary diversion –this involves surgery to divert urine from the ureters to a length of bowel which is brought to the abdomen as a stoma

Preparation for a male sling

You may be instructed as below:

• Do not take any blood thinning medications, such as Aspirin, one week prior to the procedure

• Please inform your Urologist regarding any blood-thinning or anti-clotting medications you may have

What do I have to expect after the male sling procedure?

• You should expect to stay in the hospital after the surgery for one night for monitoring

• You may resume your regular diet after the procedure. Keep your bowel movements regular and avoid constipation

• Avoid physical exertion, strenuous activities and squatting for 6- 8 weeks after the surgery

• Most patients will have a temporary urinary catheter in place for several days depending on your clinical progress as difficulty in urination may occur after surgery. Your normal habit of urination should return after a few weeks of recovery

• Pain around the surgical site is not uncommon and can last for several weeks. Oral antibiotics will be prescribed upon discharge

When should I seek medical attention after the surgery?

Please seek medical attention if you experience:

• Significant pain at the operative site

• Difficulty passing urine

• Persistent blood or clots in the urine

• High fever

Medical advice

Please contact our Customer Contact Centre at 6555 8828 for an urgent appointment to return to the Urology Clinic during Office Hours.

For any emergency after office hours, please proceed to the KTPH Acute and Emergency Department (A&E).

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg

Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg

Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg