Male Urinary Sling Surgery
Continence male sling surgery involves the insertion of a tape (synthetic sling material) beneath the urethra to provide adequate compression and improve urinary continence.
Modern male slings have been around since mid-2000s to provide instantaneous urinary continence postoperatively. These minimally invasive male slings have been shown to be effective and safe, and can be divided into adjustable and non-adjustable types and can be implanted through retropubic (behind the pubic bone) or transobturator (through the inner thigh) route. The literature supports male sling as the treatment choice in many men with mild and moderate urinary incontinence.
Professor Chung has published extensively on male sling surgery (see below) and is considered the leading surgeon expert in Australia and worldwide. He is the only surgeon from Australia and Asia-Pacific invited to serve on the male surgery for urinary incontinence committee at the International Consultation on Incontinence, the peak body for International Continence Society. He has mentored many surgeons over the years including invitation as surgeon expert at various hospitals and surgical workshops around the world. He is often asked to see complex and salvage cases by other surgeons to restore urinary continence in difficult patients.
What preparation is required?
Male sling surgery is performed under general anaesthesia, and you should be fasted (nothing to eat or drink) for 6 hours prior to surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs which need to be stopped for 7-10 days. A mid stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken.
What happens in the operating room?
You will meet Professor Chung and your anaesthetist prior to surgery. Your procedure will be performed under general anaesthesia with appropriate anti-microbial cover. The genital area will be shaved in the theatre, and appropriate povidine surgical scrub will be performed to minimise microbial skin colonisation and infection risk.
What are the risks?
Since male sling surgery involves the insertion of a foreign device, strict microbial prophylaxis and safe surgical techniques are paramount. When performed by an expert surgeon, urinary sling surgery is a safe procedure with minimal complications.
Common complications involve:
- Pain usually around the wound sites
- Bruising, bleeding or hematoma
- Dysuria from urinary catheterisation
- Skin irritation or mild infection
- Persistent or recurrent urinary symptoms, and temporary urinary retention
Potential serious complication include
- Sling erosion or extrusion of material
- Sling infection and abscess formation
- Injury to the urethra or bladder during sling surgery
- Persistent sensory and sexual dysfunction
What to expect afterwards?
You are usually required to stay overnight to receive intravenous antibiotic for 24 hours postoperatively. Your urinary catheter and surgical dressing will be removed the next morning after your surgery. When you are comfortable and passing urine satisfactory, you will be discharged with appropriate oral antibiotics. At home you should rest and avoid strenuous physical exertion for 4-6 weeks. You are encouraged to take regular bowel aperients to soften your bowel motion and prolonged squatting is discouraged as it will potentially loosen the sling.
You will have a follow-up visit with Dr Chung scheduled at 4-6 weeks postoperatively.
Some of the key articles published by Professor Chung on male sling
- Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Trans Androl Urol. 2017;6(Suppl 2):S112-S121
- Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence- A review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician. 2017;46(9):611-666
- Chung E, Smith P, Malone G and Cartmill R. Adjustable versus non-adjustable male sling for post-prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months. Neurourol Urodyn. 2016;35(4):482-6
- Chung E, Tse V and Chan L. Four-year quality of life outcome data on mid-urethral synthetic slings in the treatment of female stress incontinence. BJU Int. 2010;105(4):514-7
- Chung E. Post-prostatectomy stress urinary incontinence: Pathophysiology and diagnosis. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY
- Chung E. Surgical treatment for male stress urinary incontinence. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY