Sling implantation in men

Sling implantation in men

Slings provide support to the pelvic floor muscles and help the urethra to better resist the pressure of a full bladder. Sling implantation aims to cure stress urinary incontinence (SUI) by compressing the urethra or repositioning the urethra in relation to the bladder neck. The goal of both techniques is to prevent urine leakage.

There are various types of slings, like two armed-slings, four-armed slings and adjustable ones. Slings can be synthetic or made of human or animal tissue. You can discuss with your doctor which option is best for you.

Which type of sling is recommended for you depends on your individual situation and needs. It also depends on the availability of different types of slings in your hospital and your surgeon’s experience with them.

When should I consider a sling?

Slings can be considered in case of mild to moderate urinary incontinence after prostatectomy. They are also recommended when other surgical treatments are not possible, or if you do not want to undergo major surgery.

A sling can be a good option after other procedures have failed. Discuss with your doctor what the best option is for you.

How are slings implanted?

For the procedure you usually receive spinal anaesthesia, but in some cases you may be recommended general anaesthesia. First, the doctor inserts a catheter to make sure that your bladder is completely empty during surgery.

The doctor then makes an incision in the perineum to insert the sling. In two-armed slings, the ends of the sling are put in position on both sides of the urethra, shaping the sling like a hammock. Then, the ends of the sling are attached to tissue either just above the pubic bone, or around the groin. In four-armed slings, two ends of the sling are attached to the groin, while two others are attached to tissue around the pubic bone.

For adjustable slings, the doctor will make additional incisions in your lower abdomen to insert an adjusting device in the body. Several adjustable systems exist.

Each type of sling has specific characteristics, results, and possible complications. Ask your doctor about his or her experience with the sling suggested to you.

Fig. 1: A common type of retropubic two-armed sling.
Fig. 1: A common type of retropubic two-armed sling.
Fig. 2: A common type of four-armed sling.
Fig. 2: A common type of four-armed sling.
Fig. 3: A common type of adjustable sling.
Fig. 3: A common type of adjustable sling.

How do I prepare for the procedure?

Before the surgery the doctor will ask for a urine sample to make sure you do not have a urinary tract infection. If you have an infection, your doctor will prescribe antibiotics before, during, and after the operation.

Your doctor will advise you in detail about how to prepare for the procedure. If you need general anaesthesia, you must not eat, drink, or smoke for 6 hours before surgery. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Your doctor will advise you on when you can start taking it again.

After the procedure

How long will it take me to get back to my daily activities?

The doctor will generally remove the catheter within 24 hours after the surgery and monitor your recovery. Usually, you can leave the hospital a few days after the procedure. If you have problems urinating or there is much post-void residual urine in the bladder, you may have to stay longer. The recommended length of hospital stay varies in different countries.

After any surgery, your body needs time to fully recover. It can take up to 6 weeks for the wound to completely heal. During this time you may experience pain in the pelvic area, or feel pain when you urinate. Your doctor can prescribe medication to deal with these symptoms.

Your wound will be checked as well. Usually, stitches that dissolve and disappear are used.

Recommendations for 4-6 weeks after the surgery:

  • Drink 1-2 litres every day, especially water
  • Do not lift anything heavier than 5 kilograms
  • Do not do any heavy exercise
  • Take showers instead of baths
  • Avoid thermal baths, or going to the sauna
  • Adapt your diet to prevent constipation
You need to go to your doctor or go back to the hospital right away if you:
  • Develop a fever
  • Are unable to urinate
  • Have heavy blood loss or pain
  • Have significant blood in the urine
  • Notice the wound starts to bleed or leak transparent fluid, or it hurts

Advantages

  • High chance of curing stress urinary incontinence
  • Long-term solution
  • Fast recovery
  • Does not have a negative effect on possible future surgical treatment

Disadvantages

  • Risk of injury to the urethra during surgery
  • Very low risk of injury to the bowel or blood vessels in the pelvic area
  • Risk of temporary urinary retention after surgery
  • Risk of urgency urinary incontinence
  • Risk of bruising or bleeding in the abdomen
  • Risk of urinary tract infection
  • Risk of erosion or infection of the sling
  • Risk of recurrence of urinary incontinence
  • Risk of needing another surgery in case the sling is not effective