The gold standard treatment recommended by NICE for Male Incontinence is the Artificial Urinary Sphincter, this treatment is also offered by Manchester Urology. However, for some men with milder forms of incontinence, they may feel that the risks associated with the Artificial Urinary Sphincter outweigh the benefits. With the Artificial Urinary Sphincter patients also have to cycle the device each time they pass urine by pressing a pump in the scrotum. Although this is relatively straightforward some men may prefer an alternative that does not require this action.
With a thorough history, examination and investigations the severity of stress incontinence is diagnosed. It is often graded as mild, moderate or severe. For those men with mild to moderate stress urinary incontinence they may want to consider a more minimally invasive procedure, that allows spontaneous voiding without the use of a pump. There are several male slings on the market but the one with the most evidence for use and length of follow up is the AdVance Male Sling. Our Manchester Urology consultant regularly places the Artificial Urinary Sphincter and the AdVance Male sling and is a Principle Investigator in the National Randomised Controlled Trial looking at alternatives in the mild to moderate group of patients with male stress incontinence.
The AdVance male sling is placed via a perineal incision to allow repositioning of, and give support to the male urethra. This is more successful in those patients who have mild to moderate stress urinary incontinence, and in those patients who have not had radiotherapy.
What to expect
One week before the operation you will be asked to provide your GP with a urine sample to ensure there is no infection. If there is infection the procedure would need to be deferred as one of the most significant risks is infection of the tape. You will also require a preoperative assessment. If you are on any anticoagulant medication (blood thinning medication) you will be advised at the preoperative assessment about when you should stop these.
You will be admitted on the day of surgery where your surgeon and the anaesthatist will see you. You will often have completed the consent form before the day of surgery but your surgeon will go through this again to ensure you understand the risks of surgery (please see Patient Information Sheet for more information on specific risks).
You will be given intravenous antibiotics during the procedure but antibiotics are not routinely given postoperatively.
The procedure is often carried out under general anesthetic but sometimes a spinal anaesthetic is used. There will be a small incision in the perineum (area between the scrotum and the anus) to allow the placement of the sling onto your urethra. Two small incisions are made in the groin to allow the passage of a trocar to allow the placement and the positioning of the sling. The trocar passes the tape from the perineum, through the obturator foramen to the groin to allow stabilization of the tape and to prevent the tape moving post operatively Figure 1.
Figure 1: AdVance Male Sling
When you wake up you will have a catheter in (plastic tube in your penis) and this is removed at either 24 or 48 hours post operation. The average length of stay is 48 hours. It is important to try and keep the incisions as clean and dry as possible. It is also important that you do not do any heavy lifting , straining or stretching for 6 weeks to allow the sling to embed in.
For the specific complications associated with the AdVance Male Sling please see the Patient Information Sheet.
If you would like to see a Manchester Urology Surgeon to discuss the Advance Male Sling in more detail then please call 0161 495 7796.