Male Sling for Urinary Incontinence

Urinary incontinence (UI) is a problem that affects millions of people worldwide. While UI is often thought of as a woman’s concern, men can also experience UI. As it relates to Dr. Natale’s practice, the most common reason for male urinary incontinence is post-prostatectomy and radiation for prostate cancer. Since prostate cancer recovery and restoration of function is a primary passion of Dr. Natale’s, the male sling plays a significant role in his practice.

What is the Male Sling?

The male sling comprises soft surgical mesh implanted fully within the body and used to support the external urinary sphincter. Knowing the anatomy of the lower urinary tract is crucial to understanding why this is important. The urinary tract has two one-way valves known as sphincters. One rests within the prostate, and the other is further downstream at the pelvic floor. When the prostate is removed, so is the valve within it. The result is that a single remaining valve is left to control urinary flow. Most patients will experience some urinary dysfunction as the remaining valve acclimates to this added pressure. However, urinary continence may not be fully restored in about 5% of patients, and these patients need help ensuring predictable urination.

The male sling best suits patients with mild to moderate urinary incontinence. This is where they may wet one to three pads daily, but not more. The procedure is performed under general anesthesia and requires about an hour of operative time. The hammock or mesh is placed under the urethra to support it, and the patient will notice that they have three incisions: one in the perineum (between the anus and scrotum) and a small incision in each thigh.

Patients are sent home with a catheter and instructions on removing it within a day or two. The male sling provides immediate relief, and patients will enjoy normalized urination upon removing the catheter.

Questions Surrounding Mesh

Many patients are concerned about the use of mesh for the sling. They may have seen news reports and litigation about female pelvic mesh in the past. The mesh we use is a distinct product proven very effective and safe.

The Risks and Considerations of the Male Sling

Since the procedure is invasive, though minimally so, there are inherent risks of surgery, including infection, blood loss, and pain at the incision site. Some patients may feel pain at the small incision sites in the thigh and pressure and discomfort in the peritoneal area. There’s also a small risk of reaction to anesthesia. While rare, we must also be aware of the risks of implanting a mesh, including the possibility of the mesh migrating, leading to lower efficacy, or mesh eroding into the urethra.

Complications are necessarily higher in radiated patients due to the damage and scarring this treatment modality causes.

While minimally invasive, the male sling may not be suitable for patients with more severe incontinence. Patients soaking more than three pads daily will likely have better results with an artificial urinary sphincter or AUS.

The Bottom Line

Most importantly, Dr. Natale wants all patients who are experiencing urinary incontinence, especially after a prostatectomy, to know the full range of options for incontinence treatment. The male sling is a safe, effective, and durable choice for many patients who otherwise would have to compromise their lifestyle to minimize leakage. 

The next step is to speak to a post-prostatectomy men’s health urologist like Dr. Natale, who can guide you in the right direction and help you understand the options for restoring continence and returning to the activities you enjoy.