Fixed or Adjustable Sling in the Treatment of Male Stress Urinary Incontinence

Results From a Large Cohort Study

Tanja Hüsch; Alexander Kretschmer; Alice Obaje; Ruth Kirschner-Hermanns; Ralf Anding; Tobias Pottek; Achim Rose; Roberto Olianas; Alexander Friedl; Roland Homberg; Jesco Pfitzenmaier; Rudi Abdunnur; Fabian Queissert; Carsten M. Naumann; Josef Schweiger; Carola Wotzka; Joanne Nyarangi-Dix; Torben Hofmann; Kurt Ulm; Wilhelm Hübner; Ricarda M. Bauer; Axel Haferkamp

Disclosures

Transl Androl Urol. 2020;9(3):1099-1107. 

In This Article

Abstract and Introduction

Abstract

Background: Fixed and adjustable male slings for the treatment of male urinary stress incontinence became increasingly popular during the last decade. Although fixed slings are recommended for the treatment of mild to moderate stress urinary incontinence, there is still a lack of evidence regarding the precise indication for an adjustable male sling. Furthermore, there is still no evidence that one type of male sling is superior to another. However, both, adjustable and fixed slings, are commonly utilized in daily clinical practice. This current investigation aims to evaluate the differences between fixed and adjustable male slings regarding indications, complication rates and functional outcome in the treatment of male stress urinary incontinence in current clinical practice.

Methods: A total of 294 patients with a fixed and 176 patients with an adjustable male sling were evaluated in a multicenter single arm cohort trial. Data collection was performed retrospectively according the medical record. Functional outcome was prospectively analyzed by standardized, validated questionnaires. Descriptive statistics was performed to present patient characteristics, complication rates and functional outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups and to correlate preoperative characteristics with the outcome. A P value <0.05 was considered statistically significant.

Results: Patients with higher degree of urinary incontinence (P<0.001) and risk factors such as history of pelvic irradiation (P<0.001) or prior surgery for urethral stricture (P=0.032) were more likely to receive an adjustable MS. Complication rates were comparable except for infection (P=0.009, 0 vs. 2.3%) and pain (P=0.001, 1.7% vs. 11.3%) which occurred more frequently in adjustable slings. Functional outcome according validated questionnaires demonstrated no differences between fixed and adjustable male slings.

Conclusions: Adjustable male slings are more frequently utilized in patients with higher degree of incontinence and risk factors compared to fixed slings. No differences could be identified between functional outcome which may imply an advantage for adjustability. However, pain and infection rates were significantly higher in adjustable MS and should be considered in the decision process for sling type.

Introduction

Over the last decade, male slings (MS) for the treatment of male stress urinary incontinence (SUI) became increasingly popular.[1] In general, sling surgery is a procedure with limited peri- and postoperative complications.[2,3] The most frequent complications are postoperative urinary retention and perineal pain[2] and the overall cure and improvement rates are described between 9% to 91.6%.[3,4] A sling procedure is recommended for mild to moderate urinary incontinence[5] although successful application has also been demonstrated in severe urinary incontinence.[6]

MS are available as fixed and adjustable devices. As fixed slings seem to have demonstrated a gradual loss of efficacy over time, the idea of adjustability is the supplement of a compressive component to the relocating effect of the sling. Therefore, the regulation of the urethral closure pressure can be better adjusted to the individual patients' needs. Although clinical results from some cohort trials exist, randomized controlled trials are pending.[3] So far, only one randomized study with a limited patient population exist[7] and furthermore, one prospective trial leaving the choice for an adjustable sling to the patient is available.[8] Thus, the choice for a specific MS type depends predominantly on the surgeons' preference and experience. No evidence exists that adjustability offers an additional benefit over other types of slings or one sling is superior to another.[5]

In order to compare the current indications and outcomes of fixed and adjustable MS in clinical daily practice, we investigated the complication rates and effectiveness of fixed and adjustable male slings in a multicentre cohort study. We present the following article in accordance with the STROBE reporting checklist (available at http://dx.doi.org/10.21037/tau-19-852).

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