A New Device for the Treatment of Post-Prostatectomy Incontinence: Adjustable Perineal Male Sling

Abstract

We describe a novel male sling device for the treatment of post-prostatectomy incontinence that allows tension adjustment over the urethra postoperatively. We report the short-term results in patients with severe incontinence who were treated with this device. An adjustable male sling procedure was performed in 19 patients with a mean age of 67.5 years (range 59 to 80) who had severe post-prostatectomy incontinence. A tissue expander, including a silicone balloon expander, a small tube and a self-sealing valve that allowed the expander to gradually fill with saline solution, was used for this procedure. A pocket was created to anchor the balloon expander in its position by suturing 2 polypropylene meshes to each other around the filled balloon expander. The empty silicone balloon expander was inserted into this pocket and the sling was placed over the urethra. The injection port was secured inside the scrotum and connected to the balloon expander. Average operative time was 63 minutes (range 45 to 90). A total of 11 patients required injections. The average number of adjustments was 2 (range 1 to 3) and average injected volume was 6.3 cc (range 5 to 10). Of the patients 15 (78.9%) were completely dry and 2 (10.5%) improved significantly to 1 to 2 pads per day at a mean followup of 17.3 months (range 12 to 25). Our short-term results suggest that a tissue expander makes the male sling procedure more effective. However, since it is a new device, long-term results are needed to evaluate durability.