Therapeutic efficacy of suburethral sling in treatment of neurogenic and non-neurogenic stress urinary incontinence in men

Abstract

Purpose: Stress urinary incontinence (SUI) is usually secondary to prostatectomy or neurological lesions in men. The results of male suburethral slings for treating male SUI are presented.

Methods: The patients with postprostatectomy incontinence (PPI) (n = 47) and neurogenic SUI (NSUI) (n = 20) underwent the suburethral sling procedure using a polypropylene mesh and cardiovascular patch. In patients with PPI, the retrograde leak point pressure (RLPP) was set at 50-60 cmH₂O, and in patients with NSUI, the RLPP was adjusted to no urine leakage without interfering catheterization. The treatment was considered successful when the patient achieved either complete or social continence at the 3-month follow-up. The revision and infection rates were also assessed.

Results: The mean age of the cohort was 63.9 ± 16.5 years; the mean follow-up period was 40.1 ± 48.7 months. The success rate was 56.7% for the entire cohort, 57.4% for the PPI group, and 55% for the NSUI group. The patients with PPI who did not receive radiotherapy had a higher success rate (63%) than those who received prior radiotherapy (33%). Among patients for whom the suburethral sling procedure was successful, those with PPI had a higher BMI, whereas those with NSUI had a higher corrected Qmax and RLPP. No significant difference in baseline abdominal LPP was observed between the two groups.

Conclusions: The suburethral sling procedure is safe and effective for male patients with SUI. Although radiotherapy reduced the success rate, intraoperative RLPP measurement enabled effective tension adjustment, particularly in patients with NSUI.

Keywords: Male sling; Male suburethral sling; Neurogenic stress urinary incontinence; Post-prostatectomy incontinence; Stress urinary incontinence; Urodynamic study.