The male slings: an effective and safe alternative surgical treatment to the artificial urinary sphincter for male stress urinary incontinence?-a narrative review.

Background and Objective: The ideal candidate for a male sling (MS) should have a mild to moderate degree of stress urinary incontinence (SUI). This narrative review article evaluates the current MS devices in the commercial market and examines the role of MS as an effective and safe alternative treatment option for male SUI. Methods: The available literature on MS was reviewed and relevant clinical studies pertaining to each MS were summarised with emphasis on device design and technology as well as specific surgical findings relating to clinical outcomes. Key Content and Findings: Over the past two decades, there have been considerable scientific advances in MS design and technology, and MS is an attractive alternative for patients who might not require or want an artificial urinary sphincter. The modern MS can be classified as adjustable or non-adjustable types and is placed either through a retropubic or transobturator (TO) approach. Strict patient selection and counselling, selection of MS with proven clinical records, and safe surgical practice are paramount to ensure a high continence rate, good patient satisfaction, and low postoperative complications. Published data on various MS materials and devices showed reasonable clinical efficacy and safety outcomes, although many of these synthetic MS devices may not be available worldwide due to a lack of regulatory approval in many countries. While the ideal MS is probably yet to be developed, continued scientific advances in slings design, mesh technology, and more refined surgical techniques will improve the continence rate and deliver better safety records. Conclusions: As clinical data matures with longer-term outcomes coupled with advances in scientific designs and technology, the ability to have and select the optimal MS for a particular patient will come to fruition.

Surgical management of post prostatectomy incontinence.

Post prostatectomy incontinence (PPI) is a well-recognized and bothersome complication following radical prostatectomy. Conservative measures such as pelvic floor physical therapy, biofeedback, and medication are first line management of PPI. When first line therapies fail, patients are offered a variety of surgical procedures based on the degree of incontinence, prior radiation therapy, and comorbidities. Among the various surgical options, placement of an artificial urinary sphincter (AUS) is the gold standard for PPI. However, AUS placement has a high rate of re-operation and requires good manual dexterity. In cases of mild-moderate incontinence, especially in patients without prior radiation therapy, male slings and proACT are a less invasive option. Bulking therapy, although highly successful for female stress urinary incontinence (SUI), is not currently advised in the treatment of male SUI. Regardless of surgical approach used to treat PPI, providers should counsel patients regarding risks of re-operation and have an open an honest discussion regarding the degree of continence that can be restored following each procedure.

[Structural health care reality in the surgical treatment of male stress incontinence in Germany]. / Strukturelle Versorgungssituation der operativen Therapie bei männlicher Belastungsinkontinenz in Deutschland.

BACKGROUND: Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is a deficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. MATERIALS AND METHODS: The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschlüssel-German procedural classification) codes from hospital quality reports from 2011-2019. RESULTS: From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, a high number (≥ 50) of radical prostatectomies/year (RPE/year) is an independent predictor of a high-volume centre (≥ 10 procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted a high number of slings (≥ 10 slings/year; -69%; -62.4 ± 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34 to 10; p < 0.001). This particularly affected departments that also had a low number of RPE/year (from 9 to 0; -100%). CONCLUSION: The situation of surgical treatment of male stress urinary incontinence in Germany shows a clear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that a gap in care has developed, as the decline was not compensated for by other surgical therapies.

Pubourethral and uterosacral male analogues suggest parallel male/female pelvic anatomy and symptom pathogenesis.

The thesis that functional/dysfunctional male/female pelvic floor anatomy are parallel, originated from two studies: a successful retropubic perineal male sling for post-prostatectomy stress urinary incontinence (SUI) and discovery of a male uterosacral ligament (USL) analogue, we named "prostatosacral ligament" (PSL). In 25 out of the studied 27 males (92.6%), it starts on both sides of the median sulcus of the prostate the ligament passes lateral to the rectum being fused with the lateral margin of the mesorectum before leaving it as it thins out to be attached posteriorly similar to the USL. The ultrasound data during straining in men and women showed the same three oppositely acting muscle vectors contracting around analogous ligaments, puboprostatic ligament (PPL) (male), and pubourethral ligament (PUL) (female). Further parallels were pubovesical ligaments (PVLs) and arc of Gilvernet as part of the continence and micturition mechanisms. Impressive evidence for parallel anatomy came from the successful cure of 22 males with post-prostatectomy SUI using a perineal retropubic tissue fixation system (TFS) minisling applied to the PPL using a similar methodology to that used in the female for PUL midurethral sling repair for cure of SUI. Laparoscopic evidence confirmed the prostate as a male analogue of the cervix, and PSLs as analogues of USLs: PSL origin from the prostate attached laterally to the mesorectum and inserted into the sacrum. Histologically, PSLs had identical features with USLs: collagen, elastin, smooth muscle, blood vessels and nerves. Virtually identical symptoms for "chronic prostatitis" (CP) and "posterior fornix syndrome" (PFS), such as chronic pelvic pain, overactive bladder (OAB), abnormal emptying, gave birth to the hypothesis, of a common pathogenesis for "CP" and "PFS", USL (or PSL) laxity. If this could be proven by "simulated operations", "CP", at least in theory, may be potentially correctible by PSL repair.

Intra/inter-observer reliability of cystoscopic sphincter evaluation in men undergoing sling surgery.

OBJECTIVES: To assess the intra/inter-observer reliability of cystoscopic sphincter evaluation (CSE) in men undergoing sling surgery for urinary incontinence and if possible to evaluate its correlation with the final clinical decision. PATIENTS AND METHODS: Two expert urologists prospectively filmed and recorded, incontinent patient's cystoscopies according to a standard scenario. Anonymised recordings where randomly offered to the same observer twice. The observers (medical students, urology residents and full urologist with 0-5, 5-10, >10 years of practice, respectively) were asked to assess and score the recordings without knowing any of the patients' characteristics. RESULTS: In total, 37 recordings were scored twice by the 26 observers. The intraclass correlation coefficient (ICC) for intra-observer reliability of the CSE was 0.54 (moderate), 0.58 (moderate) and 0.60 (substantial) for medical students, residents, and urologists, respectively. However, when stratifying observers according to their experience, the lowest agreement values were found between experts with >10 years of experience. The inter-observer reliability for the CSE ICCs ranged between 0.31and 0.53, with the lowest ICC value observed between urologists (0.31). CONCLUSIONS: The study demonstrates poor intra- and inter-observer reliability of the CSE. According to these results, a CSE does not add valuable information to the clinical evaluation. In this scenario, it should not be considered in isolation from the patient's characteristics.

Male sling adjustability: does it truly matter?

PURPOSE: Patients with post prostatectomy incontinence (PPI) seem to have different needs. Therefore, device post-operative readjustability may be a beneficial feature in PPI management, even though it lacks study support. The purpose of this study is to describe our surgical technique for male sling (MS) implantation, assess outcomes, and the impact of readjustability. METHODS: We performed a retrospective analysis of 89 consecutive patients who underwent PPI correction with MS Argus-T™ (Promedon, Córdoba, Argentina) from 2009 to 2021. The median follow-up was 48 months (12-120). Data were collected in a dedicated database. Perioperative variables were assessed. A descriptive statistical analysis was performed. Clinical and urodynamic variables were correlated with the need for readjustments and success. RESULTS: In this cohort, objective success was achieved in 80.5% of the patients (65.9% cured and 14.6% improved). A total of 85.4% of the patients met the criteria for subjective success (74.4% cured and 11% improved). For the subgroup of patients who received previous treatment for urethral stricture (US), 79% achieved objective success (63.2% cured, 15.8% improved), and 84.2% achieved subjective success (78.9% cured, 5.3% improved). For the subgroup of patients who received previous radiotherapy (RT) before sling surgery, 68.7% achieved objective success (37.5% cured, 31.2% improved), and 75% achieved subjective success (37.5% cured, 37.5% improved). Procedures for device readjustment were necessary for 27.7% of patients in the total study population. RT and previous US treatment were predictive factors for the need of readjustment, with rates of 66.7% and 61.1% (OR: 8.46; CI: 2.46-29.00; p = 0.001/OR: 6.41; CI: 2.05-20.03; p = 0.001, respectively). CONCLUSIONS: MS adjustability improved success rates, especially among irradiated patients and those with previous US. RT was an adverse predictor of total continence status even after readjustments.

Prior male sling does not affect outcomes of artificial urinary sphincter.

OBJECTIVE: To investigate the outcomes of artificial urinary sphincter (AUS) placement in patients with post-prostatectomy urinary incontinence (PPUI) with or without a prior male sling. PATIENTS AND METHODS: We performed a retrospective chart review of patients who underwent AUS for PPUI from 2007 to 2022. The primary endpoint was to determine the proportion of patients who achieved social continence, defined as self-reported use of 0-1 pad/day. The secondary endpoints were device failure rates and device failure-free survival. RESULTS: The analysis included 210 patients, with 30 (14.3%) having had prior slings and 180 (85.7%) without prior slings. After AUS insertion, 80.0% of patients with prior slings and 76.7% of those without prior slings achieved continence (0-1 pad/day). There were six (20.0%) and 53 (29.4%) device failures in patients with and without prior slings, respectively. The median device failure-free survival was not reached in patients with prior slings and was 8.9 years in patients without prior slings (P = 0.048). Limitations include retrospective nature and small sample size. CONCLUSIONS: The efficacy and safety of AUS in patients with prior slings are similar to those without. Prior sling is associated with a longer device failure-free survival. AUS remains a viable option in patients who have persistent PPI after prior slings.

AdVance™ male sling for stress urinary incontinence: Long-term follow-up and patient satisfaction.

Objectives: To evaluate long-term effects, complications and satisfaction among patients treated with AdVance™ and AdVance™ XP slings (AS) at a Norwegian specialist care hospital. Materials and Methods: Patients who had an AS implanted due to stress urinary incontinence (SUI) 2009-2016 were identified retrospectively. Demographic and perioperative data were extracted from electronic patient files. We did a patient-reported outcome measure (PROM) survey with the Expanded Prostate Cancer Index Composite (EPIC-26) urinary domain and a Satisfaction Questionnaire (SQ) 2018-2020. Cure was defined as use of ≤1 pad/day. Results: The AS was implanted in 165 patients, mainly due to mild to moderate SUI (median leakage 112 g, range 13-589 g/24 h). Preoperative urodynamics showed mild detrusor overactivity (DO) in 11 patients. At 6-week follow-up, 148 patients (90%) were cured. The most common complication was urinary retention (N = 38), transient in 32 patients (range 1-42 days). Two patients were later operated with division of the sling due to persistent retention. During clinical follow-up of up to 12 years, 27 patients were reoperated due to persistent/recurrent incontinence. The PROM survey was sent to 125 patients and 115 (92%) replied at median 73 (20-134) months postoperatively. Ninety-one (79%) used ≤1 pads/day, 97 (85%) were satisfied, one patient-reported pain. Regression analyses showed that failure (>1 pad/day) was significantly associated with a higher amount of leakage preoperatively and at the 6-week follow-up. Total cure rate in the complete cohort was 64% at median 73 (20-134) months follow-up. Conclusions: The AS shows good and persistent long-term results in patients with mild to moderate SUI. The only identified risk factor for long-term failure was higher amount of leakage preoperatively. The incidence of high body mass index (BMI), DO and previous radiotherapy was low and not significantly associated with failure but is still considered risk factors.

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Comparison Study between Artificial Urinary Sphincter and Adjustable Male Sling: A Propensity-Score-Matched Analysis.

AIMS: This study aimed to compare the outcomes of the AUS and an adjustable male sling (ATOMSTM). METHODS: It was a retrospective observational cohort study with two arms. Propensity score matching (PSM) was performed in order to limit selection bias and, consequently, a comparison between groups in terms of functional outcomes (24 h pad test and perception of improvement questionnaires), complications (overall complications, high-grade complications, reinterventions and explantations) and device survival was performed. RESULTS: 49 patients in both arms were included. The baseline characteristics were similar between the groups. The mean follow up was 43 ± 35 months. Dryness was achieved in 22 patients (44.9%) in the AUS group and 11 (22.5%) in the sling group (p = 0.03). A total of 40 patients declared themselves well improved in the sling group (81%), while 35 (71%) declared the same in the AUS group (p = 0.78). The AUS was associated with more high-grade complications, reinterventions and explantations than the ATOMSTM. Survival at 60 months was 82 ± 9% in the sling group and 67 ± 7% in the AUS group (p = 0.03). CONCLUSIONS: While the AUS may be characterized by a higher dry rate, it has an increased risk of high-grade complications and reinterventions. It is proposed that the ATOMS prosthesis can be successfully used for patients who require a less invasive procedure that maintains good functional outcomes.

Artificial Urinary Sphincters for Moderate Post-Prostatectomy Incontinence: Current Research and Proposed Approach.

Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.

Stress Urinary Incontinence: An Unsolved Clinical Challenge.

Stress urinary incontinence is still a frequent problem for women and men, which leads to pronounced impairment of the quality of life and withdrawal from the social environment. Modern diagnostics and therapy improved the situation for individuals affected. But there are still limits, including the correct diagnosis of incontinence and its pathophysiology, as well as the therapeutic algorithms. In most cases, patients are treated with a first-line regimen of drugs, possibly in combination with specific exercises and electrophysiological stimulation. When conservative options are exhausted, minimally invasive surgical therapies are indicated. However, standard surgeries, especially the application of implants, do not pursue any causal therapy. Non-absorbable meshes and ligaments have fallen into disrepute due to complications. In numerous countries, classic techniques such as colposuspension have been revived to avoid implants. Except for tapes in the treatment of stress urinary incontinence in women, the literature on randomized controlled studies is insufficient. This review provides an update on pharmacological and surgical treatment options for stress urinary incontinence; it highlights limitations and formulates wishes for the future from a clinical perspective.

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques.

Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.

A narrative review on surgical treatment options for male stress urinary incontinence.

Background and Objective: Stress urinary incontinence (SUI) can occur due to a variety of etiologies. For male patients specifically, SUI is typically thought of as iatrogenic secondary to intrinsic sphincter deficiency occurring after prostate surgery. Given the noted negative impact that SUI can have on a man's quality of life, multiple treatment options have been developed to improve symptoms. However, there is no "One-Size-Fits-All" approach to management of male SUI. In this narrative review, we sought to highlight some of the various procedures and devices available to treat men with bothersome SUI. Methods: This narrative review gathered primary resources through Medline search, and secondary resources by cross-referencing citations used in articles of interest. We started our investigation by searching for previous systematic reviews on male SUI and treatments for male SUI. Furthermore, we reviewed societal guidelines, such as the American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines and the recently published European Urological Association guidelines. Our review focused on English-language full-length manuscripts when available. Key Content and Findings: We present multiple surgical options for men with SUI. This review focuses on surgical options including 5 fixed male slings, 3 adjustable male slings, 4 artificial urinary sphincters (AUS), and an adjustable balloon device. This review includes treatment options from across the globe, although not all included devices are available in the United States. Conclusions: A great variety of treatment options exist for men with SUI, although not all Federal Drug Administration (FDA) approved. Shared decision making is paramount to generate the greatest satisfaction for patients.

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review.

Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics. As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

A narrative review of the role of the Male Stress Incontinence Grading Scale in the surgical management of male stress urinary incontinence.

Background and Objective: Surgical treatment for male stress urinary incontinence (SUI) includes transobturator slings and artificial urinary sphincters (AUSs). Historically, 24-hour pad weights have been used to objectively grade the severity of male SUI and guide management decisions. In 2016, the Male Stress Incontinence Grading Scale (MSIGS) was developed as a scoring system for the standing cough test (SCT). This test can be performed at the time of initial consultation and is non-invasive, with significantly less burden to the patient compared to historical measures of male SUI. Methods: A review of the reconstructive literature was conducted using PubMed and Google Scholar, reviewing articles that discuss the development of MSIGS, its correlation with objective measures of male SUI, and its use in guiding the choice of anti-incontinence surgical management. Key Content and Findings: MSIGS has been shown to have a strong positive correlation with the 24-hour pad weight test and the subjective patient-reported pads per day (PPD). An MSIGS of 3 or 4 is used to recommend a patient for AUS placement and a score of 1 or 2 for male sling placement. Patient reported satisfaction rates were 95% for AUS and 96.5% for sling. Further, over 91% of men in the study reported they would recommend their selected procedure to other men with a similar condition. Conclusions: The MSIGS is a non-invasive, efficient, and cost-effective way to evaluate men with SUI. The in-office SCT can be quickly and easily adopted into any clinical practice and provides immediate objective information that can be used to better counsel patients on anti-incontinence surgery selection.

Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery.

INTRODUCTION: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery. METHODS: Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. RESULTS: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067). CONCLUSIONS: AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Efficacy and Complications of the Re-Adjustable Male Sling System for Stress Urinary Incontinence after Radical Prostatectomy.

The aim of this study was to investigate the outcomes of re-adjustable male slings in pa-tients with postoperative stress urinary incontinence (SUI) following radical prostatectomy (RP). We retrospectively analyzed 18 patients with SUI following RP for prostate cancer, who were treated with re-adjustable male slings from January 2016 to December 2021. The clinical outcomes were evaluated based on daily pad usage and urodynamic studies, both preoperatively and post-operatively. The degree of SUI was categorized as either mild, moderate, or severe. Success was defined as no more pad use or significantly decreased pad use. Complications were classified ac-cording to the Clavien-Dindo system. The mean age of patients was 70.4 ± 5.9 years, and 61.1% of cases were diagnosed as locally advanced prostate cancer. Mild, moderate, and severe SUI were reported as 33.3%, 50.0%, and 16.7%, respectively. The average daily pad use after RP was 3.3 pads and there was a significant reduction in the number of daily pads used after the re-adjustable male sling procedure (3.3 vs. 1.3; p = 0.002). Overall, the operation was considered successful in 11 pa-tients (61.1%), 1 case showed improvement (5.6%), and it was considered unsuccessful in 6 patients (33.3%). Impressively, in the severe incontinence subgroup (three patients), one (33.3%) had im-provement and one (33.3%) had success. Transient perineal discomfort after the operation was the most common complaint. However, two patients had severe complications with bowel injury during sling implantation (Clavien-Dindo grade III). The re-adjustable male sling system was an efficient surgical treatment option for post-RP SUI, even in a locally advanced disease dominant population. One should pay attention to the complication of bowel perforation during surgery.

Male Stress Urinary Incontinence.

Male stress urinary incontinence most commonly presents secondary to prostate treatment of prostate cancer or benign prostatic hyperplasia, although it can be seen following trauma or secondary to neurologic dysfunction. Patient selection is supremely important when choosing the appropriate nonoperative or surgical treatment. Although most patients prefer the passive mechanism of adjustable balloon devices or slings, the artificial urinary sphincter provides the most efficacious and durable results with regard to patient satisfaction and continence. Changes in prostate treatment modalities and anti-incontinence device development will offer more surgical options for patients in the future.