Incontinence | Male | Sling
Description of Procedure
General Information
There have been a few types of male slings used over the years. This site refers to the transobturator suburethral sling (AMS Advance sling, American Medical Systems, Minnetonka MN). The male sling is a minimally invasive, outpatient procedure to treat stress urinary incontinence. This surgery has been in widespread use since 2007. The male sling aims to support the urinary sphincter during abdominal pressure increases (as with a cough, sneeze, or athletic activity), preventing loss of urine.
The Procedure
The male sling is an outpatient surgery done under general anesthesia or spinal anesthesia and usually takes 45 - 75 minutes. A 4-5cm (2 inch) incision is made in the perineum (area behind the scrotum) as well as 2 mini incisions on each side of the scrotum. The sling, made of surgical mesh (polypropylene), is then placed under the urethra and brought out through the mini incisions using specially designed instruments. The sling is then adjusted to the proper tension and cystoscopy is performed to ensure the sling is in good position. The incisions are closed with dissolvable sutures. Patents usually go home within a few hours after surgery.
Information about postoperative care can be found below.
The Goals of Surgery
The primary aim is to improve the severity of stress urinary incontinence to a satisfactory level. Most patients (80-90%) will achieve this goal. Some of these patients (about 2 out of 3) are completely dry. Please note that no long-term results (greater than 10-15 years) are yet available for this relatively new surgery.
Potential Risks
In general, the rate of any serious complication is very low making the risk-benefit profile of this surgery highly favourable. Potential risks include:
Failure to improve leakage - the results of the surgery depend mainly on the patient's characteristics (the status of the patient's urinary sphincter). Even "ideal candidates" show a 90% success rate meaning still 10% of these men will not enjoy a successful outcome. Sometimes, success may not be achieved due to technical reasons (sling loses tension or urethra slips off of sling). Patients with persistent leakage following sling surgery can still have further surgery (either with another sling or possibly an artificial sphincter).
Bleeding – The chance of significant bleeding requiring hospitalization or blood transfusion is very low (less than 1 in 100).
Infection – This risk is low and you will be given preventative antibiotics following the procedure.
Urinary retention – It is quite common to experience difficulty voiding immediately following surgery. About 1 in 3 patients will need to self catheterize intermittently for up to a few days after surgery. Alternatively, in men who are reluctant to learn self-catheterization, a catheter can be left in for 2-3 days after surgery. It is not uncommon to feel some mild slowing in urination for a few days up to a few weeks after surgery. It is very rare to experience urethral obstruction by the sling. If voiding difficulty lasts longer than a few weeks after surgery, the possibility of obstruction may be investigated further with cystoscopy (rare).
Perineal, scrotal and leg pain – The perineum is a richly innervated area and hypersensitivity and discomfort around the incision may last for several days to several weeks after the procedure. This is usually mild and easily controlled with over-the-counter pain medicatio, cushions and sitting such that there is no pressure on the perineum. The discomfort may sometimes involve the scrotum and again usually resolves within days to weeks. Inner thigh discomfort is usually mild and resoves after several days.
Urinary urgency/urge incontinence – A small number of men may have new onset urinary urgency following the sling procedure. This is probably because the bladder is adapting to storing greater volumes of urine than it has been used to in some time. This resolves in most cases, but in some medication or other therapies may be required.
On the Web
AMS Male Sling - additional info
After Procedure
If you have questions that are not answered here, please contact us.
What to Expect
Swelling and bruising of scrotum often progress for 24-48 hours before starting to improve.
May experience pain or discomfort around incision sites.
May experience inner thigh discomfort.
May have difficutly passing your urine for several days. Perform self-catheterization as needed if you have received teaching and equipment for this. Keep track of voided and catheterized volumes.
If you have an indwelling catheter please see catheter care instructions.
Cautions
Report any of the following to your doctor:
Redness, foul-smelling drainage or sepration of incision site.
Fever over 38.5 C.
Severe pain unrelieved by medication.
Inability to self-catheterize (if taught self-catheterization).Report any of the following to your doctor:
Diet
Advance to usual diet as tolerated.
Activity
Get up and about as soon as possible after surgery.
Walk as tolerated.
Use an ice bag on the scrotum for the first 24-48 hrs to reduce swelling. Wrap the ice bag in a washcloth. Do not apply ice directly to skin. Apply 15 minutes on and 15 minutes off while awake.
Avoid lifting more than 20 lbs for one month.
Avoid “high stepping” or spreading your legs far apart.
Avoid pressure on your incision behind your scrotum.
Use a soft pillow or horseshoe cushion for sitting.
You may start showering 24-36 hrs after surgery. Avoid water stream directly on incision. You may sponge bathe. Do not submerge in a tub bath for 3-4 weeks.
You may start driving about 5-10 days after surgery. Do not drive if you are still on narcotic pain medication or have limited mobility.
Medications
Take antibiotics as per prescription.
Use prescription pain medication as needed.
Take a stool softener (obtain over the counter at local pharmacy) starting the night of your surgery. Stop taking stool softeners once having soft bowel movements. Do not take stool softeners if diarrhea occurs.
If you have not had a bowel movement by the 3rd day after your surgery, take a laxative (obtain at your local pharmacy over the counter).
You may begin your regular medications when you leave the hospital unless instructed otherwise.
If you take blood thinners (ASA, plavix, warfarin), your doctor will advise when you can start them again.
