West Coast Urology  –  Geelong   |   Hamilton    |   Colac   |   Winchelsea

A. PROF RICHARD GRILLS

DR KATHRYN MCLEOD

MR PATRICK PREECE

Urological Surgeons

Male Urethral Sling

To read more information about a ‘male urethral sling’ please click:

Reasons for performing the procedure

  • A surgical treatment for male ‘stress’ incontinence (urine leakage) which typically occurs due to injury of the urethral sphincter (a pelvic floor muscle that helps control continence).

  • The most common causes include:
    • Prostatectomy (removal of the prostate due to cancer)
      • Approximately 10% of prostatectomy patients will have incontinence that persists beyond a year
    • Radiotherapy for prostate cancer
    • Other surgical treatments for benign prostate enlargement (BPH)
    • Pelvic trauma

  • Urine leakage from stress incontinence typically occurs during moments of increased abdominal pressure which overpowers the weakened sphincter mechanism. Such triggers include laughing, sneezing, coughing, bending over, lifting, sex and exercise.

What is a urethral sling?

  • It is a surgically placed mesh tape that wraps around the underside of the urethra and pulls upwards.
  • It works by a combination of dynamic compression and repositioning of the section of urethra located below the bladder.
  • The device is completely hidden inside the body and works instantaneously to restore continence.


Results

  • Following sling insertion in men with mild to moderate urinary incontinence:
    • 25% are completely dry,
    • A further 50% are much better, and
    • 25% notice no significant improvement
  • Men with severe incontinence tend to have poor results and are better suited to an ‘artificial urinary sphincter’.

It is generally inadvisable to insert a sling in a man that has:

  • Leakage of more than 300mL of urine in 24 hours,
  • Undergone (or is likely to need) radiotherapy for prostate cancer, or
  • Has a weak bladder that may not be able to generate strong enough pressures to overcome the resistance of the sling when trying to urinate


For these men, a sling is likely to be far less effective or have higher rates of complications. Instead, an ‘artificial urinary sphincter’ is usually the preferred incontinence treatment.

Alternative stress incontinence treatments

Though the urethral sling can be a life-changing operation for men bothered by urinary incontinence, your surgeon will discuss any other appropriate alternative strategy. These treatments can include:

  • Lifestyle modifications
  • Pelvic floor physiotherapy
  • Penile clamps
  • Catheters
    • Condom catheter
    • Indwelling catheter
  • Male ‘artificial urinary sphincter’
    • This is an alternative surgical solution that is better suited to some men.

 

TO FIND OUT MORE

Follow this link: https://www.menshealthtreatments.com.au/treatment-options/artificial-urinary-sphincter.html

 

  • The procedure takes approximately 1 hour and is performed under a general anaesthetic.
  • It is completed through a main incision between the legs (behind the scrotum) and a small incision in each groin crease.
  • A temporary catheter is inserted during the surgery.
  • The sling is tensioned, aiming for “not too tight” and “not too loose”… just right!
  • Usually only an overnight stay in hospital is required. The catheter is removed the morning after surgery prior to discharge.
  • Bleeding– Some bruising between the legs, of the scrotum or lower abdomen may occur. It usually settles quickly. Major bleeding is rare.
  • Infection– Minor wound infections can be treated successfully with antibiotics. Severe infections involving the implant are thankfully uncommon (<5%). Diabetic patients have a higher risk of infection.
  • Erosion– Rarely the sling can erode through the wall of the urethra resulting in troubles urinating and infection. In such cases the sling needs to be removed.
  • Persistent incontinence- Not all men are perfectly dry after this surgery and still require the use of occasional incontinence pads.
  • Urinary retention- the sling can ‘block off’ the urethra (especially in men with weak bladders) such that some men may struggle to urinate at all. In such cases the sling can either be divided or men taught to pass catheters. To minimise the risk of this complication, the function and ‘strength’ of the bladder is assessed prior to surgery.

Other important investigations

  • Two special tests are usually recommended in the lead up to surgery to confirm whether a urethral sling is the most appropriate treatment:
    • Cystoscopy (the suitability of the urinary tract anatomy is assessed by passing a telescope through the urethra and to the bladder)
    • Urodynamic studies (a test that analyses the behaviour of your bladder to evaluate other possible causes of urinary incontinence)


Pre-operative tests:

  • 7-10 days prior to surgery you will have routine blood tests and provide a urine specimen to check for any infection. You will be notified if you require antibiotics in the lead up to surgery.


Before the surgery:

  • DO NOT shave around the penis and scrotum in the weeks leading up to surgery– you will be freshly shaved at the time of surgery to minimise the risk of infection.
  • Please ensure good genital and groin hygiene. It is important you notify your surgeon if you develop any rashes or infections (e.g. jock itch) prior to surgery.

 
Medications to stop:

  • Notify your surgeon if you take any blood thinners, medications for diabetes or medications that weaken your immune system as these may need to be withheld in the lead up to surgery.


Antibiotics

  • To minimise the risk of infection, antibiotics are used during and after the surgery.
  • Please notify your surgeon if you have any known allergies (e.g. penicillins).

  • One of the antibiotics sometimes used during the surgery is called Gentamicin. It is a very effective antibiotic but has some potential (although fortunately rare) complications:
    • Tinnitus (a ‘ringing in the ear’, which in some cases may be irreversible)
    • Kidney damage (typically with only high doses and prolonged use)
  • Please notify your surgeon if you have pre-existing hearing difficulties or kidney troubles.

Wound care

  • All the stitches are dissolvable.
  • Keep the wounds clean and dry for 24 hours after surgery. You can then shower as normal, but ensure the wound is dry afterwards (pat dry with a towel or use a hair dryer)
    • Avoid baths or long showers which may macerate or ‘soften’ the skin around the wound
  • The waterproof wound dressings will be removed at a review appointment with the nurse in the week following surgery. If the dressings become wet or fall off beforehand, leave the wound exposed, and keep it clean and dry.


Recovery

  • Swelling and bruising can last for a week or two.
  • Constipation is common following surgery and is often exacerbated by the use of strong pain medication. It is important to avoid straining on the toilet which can increase the risk of bleeding etc following surgery.
  • To prevent/ treat constipation, maintain good fluid intake, high fibre foods and use laxatives as required
  • Pain and discomfort is expected for a couple of weeks. It will take up to 6 weeks before complete healing occurs.


Exercise and activity

  • Avoid any movement that involves leg spreading or squats for 4-6 weeks. If tension is applied to the sling before it has a chance to properly ‘scar’ into place, there is a risk of it becoming ‘slack’ and incontinence returning.
  • Avoid strenuous activity, physical work, sexual activity and exercise for 6 weeks.


Driving

  • It is safe to resume driving only when you are off all pain medications, are moving around freely and are comfortable sitting in an upright position.


Medications

  • You will be given when you leave hospital:
    • Tablet antibiotics
    • Pain relief medication
    • Laxatives to prevent/ treat constipation


Follow up appointment

  • You will reviewed in the rooms:
    • One week after surgery
    • Six weeks after surgery

  • You will be asked to perform a urine flow test and undergo a bladder scan at these appointments to assess how well your bladder is emptying with the sling in place.
  • Please attend these appointments with a comfortably full bladder, or arrive early so you can drink a few cups of water whilst in the waiting room.


If you did not receive an appointment when leaving hospital, please contact reception staff at West Coast Urology to make one.


Contact your surgeon if you notice any of the following during the recovery period:

    • Fever
    • Worsening pain, increased swelling, redness or wound discharge
    • The wound opening up
    • Difficulties urinating