The male sling for post-prostatectomy incontinence: Mean followup of 18 months

Purpose: We review our experience with 42 consecutive patients undergoing the bone anchored male sling procedure. Materials and Methods: A retrospective chart review was performed, and complete data and followup were available in 38 of the 42 patients. Success was defined as wearing 1 thin pad or less per day, or social continence. Variables such as severity of incontinence, age, detrusor overactivity, previous artificial urinary sphincter, history of radiation and intraoperative flow pressures were analyzed for success and risk of failure. Results: With a mean followup of 18 months (range 6 to 26), 39.5% (15 of 38) were considered a success (socially continent). A statistically significant trend in the degree of preoperative incontinence predicting success was identified. Social continence in mild, moderate and severe cases was achieved in 67%, 50% and 0%, respectively (p =0.001/95% CI). Only 15.8% of patients were completely dry and not wearing pads. Significant perineal pain was reported in the early postoperative period but resolved in all patients. Infection occurred in 3 patients with erosion found in 1. Conclusions: Although these results are not as encouraging as previous reports, carefully selected patients with mild to moderate incontinence are good candidates for the male sling. Patients with a history of radiation, previous artificial urinary sphincter or severe incontinence should be counseled about the higher risk of treatment failure. Patients should be informed of the possibility of progressive failure with time and the occurrence of significant perineal pain in the early postoperative period.