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


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

In This Article


The study was approved by the local ethics committee of Frankfurt university hospital (ethic vote number 442/13). We conducted a multicenter single arm cohort study including a total of 470 patients who have received a fixed or adjustable MS for male stress urinary incontinence in the study centers between 2010 and 2012. Patients were enrolled retrospectively in Germany and Austria, thus, selection criteria for a fixed or adjustable sling was not standardized. Baseline characteristics, perioperative data and complication rates were collected retrospectively according the medical record. Standardised and validated questionnaires were prospectively completed by the patients at time of enrolment. A signed informed consent was mandatory for this investigation. The following questionnaires were used: "Incontinence – Quality of Life"[9] (I-QoL; scale: 0–100, a higher score represents better QoL), "Patient Global Impression – Improvement"[10] (PGI-I; range 1–7, very much better to very much worse), "International Consultation on Incontinence Questionnaire – Short Form"[11,12] (ICIQ-SF; range: 0–21, 0: no incontinence, 1–5: slight, 6–12: moderate, 13–18: severe, 19–21: very severe), "Verbal Rating Scale of Pain" (VRS; range 0–10, a higher score represents more pain). Furthermore, the number of pads used per day and a 24-hour pad test were evaluated. Complications were evaluated according the Clavien Dindo Classification.[13] Results were compared between the fixed and adjustable MS group. Functional outcome of fixed and adjustable MS group was additionally correlated with the confounders grade of incontinence,[1–3] history of pelvic irradiation and prior surgery for urethral stricture disease. Additional subgroup analysis was performed in case of significant differences between the groups to identify confounder by utilized device. Quantitative variables were not grouped. Missing data have been handled in an available cases analysis approach.

Statistical Analysis

Statistical analysis was performed by IBM SPSS (Armonk, New York, United States) Statistics Version 22 for Macintosh. Descriptive statistic was applied for presentation of population characteristics, complication rates and outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups. Correlations of baseline categorial variables with continence outcome were performed by the chi2-test. A significance level of 5% was determined.