Study: Cure rate of 80% seen with male sling

Chicago-A non-bone-anchored male sling appears to resolve mild to moderate post-prostatectomy incontinence in up to 80% or more of patients, a number of whom also may see a clinically significant improvement in erectile and sexual function.

Brian Christine, MD, a urologist who is in private practice in Birmingham, AL, presented findings from one of the first North American studies of the AdVance Male Sling (American Medical Systems, Inc, Minnetonka, MN) at the AUA annual meeting.

"This is a transobturator male sling," said Dr. Christine, who worked on the study with Anthony Bella, MD, of the University of Ottawa, Ontario, and colleagues. "That is important to note because there are other male slings, but they are anchored to the bone. This is more like the female sling in that it is anchored to muscle with sutures. There are no screws to place."

At a median follow-up of 12 months, 16 men (80%) were completely dry and three were improved but continued to use one to two pads a day. One patient showed no improvement.

A supplemental finding revealed improvements across key sexual function/satisfaction domains in six patients (30%). The benefits in-cluded improved erectile rigidity and maintenance of tumescence with no concurrent changes in erectile dysfunction pharmacotherapy-an improvement of 6 or more points across the erectile domain measures.

The mechanisms underlying this novel finding have yet to be described.

"We don't know exactly why sexual function improves," Dr. Christine told Urology Times. "It may be related to the fact that these patients no longer experience incontinence during sex. That is a big deal. When they are not leaking during intercourse or sexual activities, they certainly experience a much greater interest in and satisfaction with sex. It must be noted that these patients already have some post-prostatectomy erectile function. The im-provements are seen soon after the sling is placed."

Outpatient sling placement

Placement of the sling is an easily learned procedure that takes 30 to 45 minutes and can be conducted as an outpatient procedure, Dr. Christine said.

The patient can be under general or spinal anesthesia for placement. The sling, a pre-cut, non-resorbable polypropylene monofilament mesh, is placed via a midline perineal incision. Two small stab incisions are also made, one on each side of the inguinal crease. The sling comes as a kit containing two single-use needle passers and a sterile mesh with attached connectors. Placement is permanent.

Dr. Christine advised against placing the sling too proximal to the bulbar urethra.

The study, though small, is promising and additional studies will follow. Dr. Christine anticipates that many of the future studies will now contain a component that assesses the device's effects on sexual function.

"This sling is effective in treating mild to moderate post-prostatectomy incontinence," he said. "It carries a low risk of complications. The procedure is straightforward and easily learned, and men who have the sling may experience improved sexual function related to satisfaction and desire. In a subset of men, there may be improvement in erectile function."