Bone-anchored Sling Research Articles

Bone‐anchored sling using the Mini Quick Anchor Plus and polypropylene mesh to treat post‐radical prostatectomy incontinence: Early experience

Herein we describe our experience with a bone-anchored sling using a suture anchor and polypropylene mesh for the treatment of post-radical prostatectomy urinary incontinence. Eight patients with urinary incontinence as a result of intrinsic sphincter deficiency after radical prostatectomy were included in the analysis. The procedure involved piercing the pubic bone with a bone drill, inserting the suture anchor and fixing a soft or rigid polypropylene mesh to press firmly on the bulbar urethra. Urinary incontinence was significantly improved according to changes in the daily number of pads used at 1, 3 and 6 months postoperatively in comparison with preoperatively. However, no meaningful improvement at 6 months postoperatively was seen with the soft mesh. Complications included perineal pain in four cases, but pain control was achieved using non-steroidal anti-inflammatory drugs. The bone-anchored sling with a suture anchor and polypropylene mesh appears to be safe and effective for the treatment of post-radical prostatectomy urinary incontinence. Soft mesh appears inappropriate as material for the bone-anchored sling because of the progressive likelihood of worsened urinary incontinence.

Initial Experience and Results With a New Adjustable Transobturator Male System for the Treatment of Stress Urinary Incontinence

We report on our initial experience in terms of efficacy and safety with a new, self-anchoring adjustable transobturator male system (A.M.I.® ATOMS System) for the treatment of male stress urinary incontinence after prostate surgery. In this prospective, nonrandomized single center study conducted between March and December 2009, patients with stress urinary incontinence secondary to prostatic surgery were treated with the ATOMS device. Urethroscopy, filling and voiding cystometry were performed preoperatively for all patients. In addition, incontinence symptoms were assessed, and a physical examination, 24-hour pad test and 24-hour pad count were performed before and after surgery. A total of 38 patients were included in the study (36 after radical prostatectomy, 2 after benign prostatic hyperplasia surgery). No intraoperative complications occurred. Mean number of adjustments during followup was 3.97 (range 0 to 9). At a mean followup of 16.9 months (range 13 to 21) the overall success rate was 84.2%. Of the successful cases 60.5% were considered dry (0 to 1 pad and less than 15 ml/24-hour pad test) and 23.7% improved (more than 1 pad per 24 hours but more than 50% decrease in pad use and less than 100 ml per 24-hour pad test). In 15.8% of the patients the treatment was considered to have failed (more than 2 pads daily and greater than 100 ml on 24-hour pad test). The treatment of male stress urinary incontinence with the ATOMS is safe and effective. It is an excellent first or second line treatment for mild to moderate male stress urinary incontinence, even after external irradiation. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage of this new implant.

Male Stress Urinary Incontinence: A Review of Surgical Treatment Options and Outcomes

Introduction and Objective. Iatrogenic male stress urinary incontinence (SUI) affects a percentage of men undergoing urologic procedures with a significant impact on quality of life. The treatment of male SUI has evolved significantly with multiple current options for treatment available. The current paper discusses preoperative evaluation of male SUI, available surgical options with reported outcomes, and postoperative complication management. Methods. A pubMed review of available literature was performed and summarized on articles reporting outcomes of placement of the artificial urinary sphincter (AUS) or male slings including the bone anchored sling (BAS), retrourethral transobturator sling (RTS), adjustable retropubic sling (ARS), and quadratic sling. Results. Reported rates of success (variably defined) for BAS, RTS, ARS, and AUS are 36–67%, 9–79%, 13–100%, and 59–91% respectively. Complications reported include infection, erosion, retention, explantation, and transient pain. Male slings are more commonly performed in cases of low-to-moderate SUI with decreasing success with higher degrees of preoperative incontinence. Conclusions. An increasing number of options continue to be developed for the management of male SUI. While the AUS remains the gold-standard therapy for SUI, male sling placement is a proven viable alternative therapy for low-to-moderate SUI.

Bone-anchored Sling Created with the InVance<sup>TM</sup> System for the Treatment of Incontinence after Radical Prostatectomy: Initial Experience in Japan

This report describes creation of a bone-anchored sling with the InVance™ system (American Medical Systems, Minnetonka, MN, USA) for the treatment of 2 patients with incontinence after radical prostatectomy. The InVance™ system uses a silicon-coated polyester sling positioned under the bulbar urethra via a perineal incision. The sling is attached to both ischiopubic rami by 3 titanium screws. Operative times were 157 minutes (patient 1) and 240 minutes (patient 2). Blood loss was 70 mL (patient 1) and 10 mL (patient 2). The patients used 7 and 5 absorbent pads/day, respectively, before surgery and 1 and 0 pads/day after surgery (this datum does not appear in the main text, although the absence of incontinence is mentioned). The only major adverse event encountered was mesh infection necessitating mesh removal in patient 2. This operation appears comparatively simple and useful.

The male sling for post‐prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes

To examine the outcomes and adverse events associated with novel male sling designs described in the last decade. A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database. Three principal slings are described in the literature. The bone-anchored sling has success rates of 40-88%, with some series having a mean follow-up of 36-48 months. It is associated with a mesh infection rate of 2-12%, which usually requires sling explantation. The retrourethral transobturator sling has a success rate of 76-91% among three large case series with follow-ups of 12-27 months. There is a low reported explantation rate. The adjustable retropubic sling has a success rate of 72-79% with follow-ups of 26-45 months. Erosion (3-13%) and infection (3-11%) can lead to explantation. Most male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid- and long-term data are now available that indicate the male sling is a viable option for PPI. The use of male slings in severe UI, radiated patients, and non-radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.

2160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE Craig Comiter, Christopher Payne, and Richard Vecchiotti Craig ComiterCraig Comiter Stanford, CA More articles by this author , Christopher PayneChristopher Payne Stanford, CA More articles by this author , and Richard VecchiottiRichard Vecchiotti Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Innovations in male sling surgery have contributed to an increased interest in their use for the treatment of stress urinary incontinence (SUI). There is controversy, however, regarding their mechanism of action for improving continence. Bone-anchored slings appear to compress the bulbous urethra, as evidenced by increased retrograde leak point pressure (RLPP). Retroluminal (transobturator) slings, on the other hand, are purported to function by repositioning a ‘mobile' urethra and external sphincter back into the pelvis, thereby increasing functional membranous urethral length. As the prevalence of male urethral mobility is not well-defined, we describe a novel video-urodynamic technique designed to measure urethral mobility in men with SUI. METHODS 22 men with SUI were evaluated with video urodynamics. Fluoroscopy (3.75 frames/s) was performed at rest and during strain. Magnification differences in captured images were normalized by a 1/4” steel sphere (scaling factor) within the field of view. The ‘rest' and ‘maximal straining-induced displacement' frames were imported into a Computer Aided Design program.Reference geometries were constructed and measured about the structures of interest. A fixed tissue reference (FTR) line was created tangent to and coincident with the inferior boundary of the pubic ramus. A second line was created parallel to the FTR line coincident with the lowest point of functional continence (LPFC) – the point at which the contrast agent boundary was closest to the FTR line. Normalized measurements were made between the FTR and the LPFC in ‘rest' and the 'maximal straining-induced displacement' frames. Urethral mobility was calculated as the difference between the FTR and LPFC in each frame. RESULTS 9 men were status-post prostatectomy, 9 had external beam radiation (XRT), and 4 had neurogenic SUI. The mean maximal displacement (mobility) was 0.167 ± 0.059 inches in men with post-prostatectomy SUI, compared to 0.0841 ± 0.0261 inches in SUI men after XRT and 0.275 ± 0.161 inches in men with neurogenic SUI. CONCLUSIONS We have created a novel method to measure urethral mobility in men. We will expand this study to determine the relationship among urethral mobility, leak point pressure, degree of incontinence, and ultimately to response to various sling surgeries. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e864-e865 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Comiter Stanford, CA More articles by this author Christopher Payne Stanford, CA More articles by this author Richard Vecchiotti Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY Hanhan Li, Bradley Gill, Amy Nowacki, Hadley Wood, and Sandip Vasavada Hanhan LiHanhan Li Cleveland, OH More articles by this author , Bradley GillBradley Gill Cleveland, OH More articles by this author , Amy NowackiAmy Nowacki Cleveland, OH More articles by this author , Hadley WoodHadley Wood Cleveland, OH More articles by this author , and Sandip VasavadaSandip Vasavada Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling is a viable option for patients who experience mild to moderate incontinence after prostatectomy. Previous studies have demonstrated quantitative success in treating post-prostatectomy incontinence (PPI). This study focuses on the durability of patient perceived efficacy. METHODS Telephone survey and retrospective chart review were conducted on patients receiving a sling prior to 2010 by either of two surgeons at a large academic institution. Of this group, 35 patients were previously surveyed in 2008. Telephone survey included the Patient Global Impression of Improvement (PGI-I) and Severity (PGI-S) of incontinence, questions concerning pre- and post-sling pad quantity, type, and usage, and durability of sling efficacy. Patient-determined success was defined as “very much” or “much” better PPI on the PGI-I without subsequent incontinence therapies. Patients lost to follow-up were analyzed as failures. RESULTS A total of 67 patients (mean age 67, BMI 27) received the sling at median 23 months [Q1–Q3: 14–90] post-prostatectomy. PPI treatments included Kegel exercises (27%), external clamp (7%), anticholinergics (25%), collagen (12%), durasphere (4%), bone-anchored sling (1%), and artificial urinary sphincter (AUS) (7%). Per chart, a mean 2.8 (SD 2.3) pads were used daily pre-sling. Telephone follow-up was successful in 58 (87%) patients at a mean of 23 months post-sling. Patients reported improvement in PPI as “very much” (41%), “much” (19%), and “a little” (14%) better. Of the rest, 16% reported “no change” or worsening PPI as “a little” (3%), “much” (5%), and “very much” (2%) worse. Pad usage post-sling decreased from 3 to 1.5 (p<0.0001). For patients whose post-sling improvement worsened over time (n=20), only one felt something “tear” or “pull” after surgery. Men who responded to both surveys (n=23) with mean follow-up at 9 and 31 months post-sling reported an increase in daily pad use from 1.3 to 2.1 (p=0.03). A total of 15 (22%) patients sought additional incontinence therapies: bulking injections (4), AUS (4), external clamps (4), exercises (3), medications (2), and acupuncture (1). Overall patient-determined success rate, as defined, was 43%. Patients new to this second study had success at first follow-up (53%) similar to those previously assessed, who now show reduced (32%) patient-perceived effectiveness. CONCLUSIONS Most patients receiving the AdVance™ sling do see improvement in PPI and a decrease in pad usage but durability of perceived benefit decreases over time, requiring some patients to seek further therapies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e539 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hanhan Li Cleveland, OH More articles by this author Bradley Gill Cleveland, OH More articles by this author Amy Nowacki Cleveland, OH More articles by this author Hadley Wood Cleveland, OH More articles by this author Sandip Vasavada Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Are male slings for post-prostatectomy incontinence a valid option?

Stress incontinence in men is still a common problem after surgical treatment of prostatic disease. This article reviews the techniques and results of recently described surgical slings available to treat male stress incontinence. Medium-term follow-up (mean 3-4 years) of patients treated with bone-anchored slings has been recently published, suggesting a success rate (cured or improved) of 70-80%. Short-term follow-up (mean of 6-12 months) of transobturator retrourethral slings demonstrates a success rate of 62-83%. Novel sling designs include mechanisms to manipulate the tension postoperatively and inside-out transobturator trocar passage. Common complications associated with slings are acute urinary retention and perineal pain. Rare complications include urethral erosion and infection. Retropubic approaches are associated with a risk of bladder perforation. Male slings are a valid option for treating male stress incontinence, and do offer several advantages over the artificial urinary sphincter. However, long-term data and multicenter series are needed in order to compare directly with the artificial urinary sphincter.

Bone-anchored Sling for Male Stress Urinary Incontinence: Assessment of Complications

To evaluate the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. We retrospectively reviewed 119 men who had undergone 140 BAS procedures for SUI from May 2000 to May 2009 at our institution. All complications were recorded during the follow-up visits. Pad test and questionnaire results were recorded, as available. BAS was performed in 140 cases for 119 men with SUI. Mean patient age was 65.8 years (range 23-89). Main etiologies for SUI included previous treatment of prostate cancer (82.4%), neurologic dysfunction (12.6%), and previous transurethral resection of the prostate (3.6%). Recurrent SUI, de novo urge incontinence, and wound infection were the most frequent complications encountered (25.2%, 17.6%, and 16%, respectively). The 3 most common reasons for reoperation included bulking agent injection for recurrent SUI (5.9%), sling revision for bone screw dislodgement (5.9%), and sling revision for recurrent SUI (5.0%). Overall complication and reoperation rate for the index cases was 58.8% and 26.9%, respectively. The incidence of complications after male BAS placement might be greater than previously reported. Patient counseling before surgery regarding the potential complications is important. Men treated for prostate cancer should be informed of the risk of recurrent SUI. In appropriately selected patients, we believe the BAS is a reasonable surgical option; however, the risk of postoperative complication is not equivocal.

The Modified Invance Perineal Sling in the Treatment of Incontinence in Boys with the Exstrophy-Epispadias Complex

Purpose The surgical management of incontinence in boys with the exstrophy-epispadias complex has challenged surgeons for many decades. We present a modification of our previously described sling for the treatment of neurogenic incontinence to permit the treatment of these patients. Material and Methods Two boys aged 11 and 18 with the exstrophy-epispadias complex were treated for severe urinary incontinence. The 11 year old was status post a Mitchell single stage repair with an anterior iliac osteotomy. The 18 year old had undergone a staged Cantwell –Ransley repair with a posterior iliac osteotomy. Both patients underwent the placement of an AMS InVance sling modified with the creation of a midline polypropylene bolster to permit adequate urethral compression while obviating corporal compression. Both procedures were discharged home the day of surgery. Results Both patients immediately had an improvement in continence and were able to volitionally void without CIC. With a follow-up ranging to 26 months, both patients maintain a significant clinical improvement. The 18 year old has minor spotting with valsalva but is otherwise dry both day and night. The younger boy required the placement of a larger bolster 7 months following his initial repair but remains largely dry with occasional daytime pad use for mild stress incontinence. Both patients are on oxybutynin and have not undergone bladder augmentation. Conclusions The modified bone-anchored perineal sling is a simple out-patient option in the treatment of this difficult problem. Long-term studies with larger number of patients will be required to determine the ultimate role of this new procedure.

Bone-anchored suburethral sling: Surgical technique and outcomes

The gold standard treatment for stress urinary incontinence (SUI) is the autologous rectus fascia pubovaginal sling. Although successful, it is associated with increased morbidity related to the graft harvest. Because of this, less invasive techniques were developed, including the retropubic and trans-obturator midurethral sling and the bone-anchored sling (BAS). Early reported outcome failures and concern for bone-anchored-related complications caused BAS to fall out of favor. However, technique modifications and use of a more durable graft or mesh have proven that the transvaginal placement of BAS is actually safe and effective in treating patients with SUI. Further, recent evidence suggests that the bone-anchored sling may be a reasonable option for treatment of patients with moderate to severe and/or recurrent SUI.

Editorial Comment

It is widely accepted that the artificial urinary sphincter is the reference standard for treatment of postprostatectomy stress incontinence, but we have been striving to develop more minimally invasive options. The minimally invasive options include bulking agents, readjustable periurethrally implanted balloons, perineal bone-anchored slings, readjustable retropubic slings, and transobturator slings. Unlike the artificial urinary sphincter, many sling techniques provide compression exerted in 1 direction, which results in both effective continence and efficient voiding. In contrast to slings that provide fixed urethral compression, male transobturator slings are believed to restore physiologic voiding and continence without compression. Urodynamic Changes and Initial Results of the AdVance Male SlingUrologyVol. 74Issue 2PreviewTo present the urodynamic changes and early results associated with the AdVance male sling. The AdVance male sling is a treatment option for postprostatectomy incontinence (PPI), with the goal of eliminating urinary incontinence without affecting voiding parameters. A concern of any procedure in treating men with PPI is whether the treatment induces obstruction and causes retention. Full-Text PDF Editorial CommentUrologyVol. 74Issue 2PreviewIn 2007, Rehder and Gozzi1 published their pilot study analyzing the anatomic effects of placing a transobturator tape in cadavers, as well as its clinical efficacy in a small cohort of men with postprostatectomy incontinence (PPI). The hypothesis for the transobturator tape is that relocating the membranous urethra into a more proximal position, without disturbing the sphincter mechanism, would improve continence. The cadaveric group in their study demonstrated an increase in the membranous urethral length. Full-Text PDF

Placement of a transvaginal bone-anchored sling: A new minimally invasive technique is useful in stress urinary incontinence

Placement of a transvaginal bone-anchored sling: A new minimally invasive technique is useful in stress urinary incontinence

Transvaginal Bone-Anchored Sling Procedure: 4 Years of Follow-Up on More than 200 Consecutive Patients

Transvaginal Bone-Anchored Sling Procedure: 4 Years of Follow-Up on More than 200 Consecutive Patients

Editorial Comment

The authors present symptomatic follow-up data on the use of bone-anchored slings for stress urinary incontinence. Longer term data are crucial as new technologies are presented to pelvic surgeons for possible inclusion in the surgical armamentarium. The 5-year data, as reported, is vital to assist in the critical analysis and assessment of newly proposed interventions.

Transvaginal Bone-Anchored Sling Procedure: 4 Years of Follow-Up on More than 200 Consecutive Patients

To report intermediate-term results with reference to quality of life (QoL) and complications in 232 consecutive patients with stress urinary incontinence (SUI) treated with a transvaginal pubic bone-anchored sling (BAS). We retrospectively reviewed 232 consecutive patients affected by SUI who underwent BAS using biologic and synthetic materials, with a mean follow-up of 50 months. Stress urinary incontinence was due to a defect of anatomic support and to intrinsic sphincteric deficiency in 220 patients and 12 patients, respectively. In all cases QoL was evaluated by Korman questionnaire. The questionnaire outcomes of 232 patients were evaluated. One hundred seventy-three patients (74.5%) reported being cured, 21 patients (9.0%) were unchanged, and 38 patients (16.5%) failed. One hundred seventy-seven patients (76.2%) were satisfied with the BAS procedure, and 38 (16.3%) would perhaps still choose BAS implantation, whereas 17 patients (7.5%) would not repeat this choice again. Sixty patients (25.8%) reported pelvic pain that was occasional in 47 patients (20.2%) and recurrent in 13 patients (5.6%). Twenty-five patients (14.1%) reported dyspareunia that was occasional in 17 patients (10.7%) and recurrent in 8 patients (3.4%). The BAS procedure shows an overall acceptable subjective cure rate, even if in the presence of a high percentage of complications. In this setting the BAS procedure cannot be proposed for correction of SUI.

Transvaginal bone-anchored sling for the treatment of female stress urinary incontinence: effect of Valsalva leak point pressure and prior pelvic surgery on outcomes

The effect of lower Valsalva leak point pressure (VLPP) and previous pelvic surgery on outcomes following sling surgery is controversial. We assessed outcomes following bone-anchored sling (BAS) placement in patients with intrinsic sphincteric deficiency (ISD) and previous pelvic surgery. A retrospective review of 149 patients undergoing BAS placement was performed. Patients were stratified by VLPP (> or =60, <60, and <30) and by history of previous anti-incontinence/pelvic floor surgery. Outcomes were assessed using a questionnaire comprising validated urogenital distress inventory (UDI)-6, incontinence impact questionnaire (IIQ)-7 questionnaires and additional items addressing satisfaction. In comparing the three VLPP cohorts, the percentage of patients reporting incontinence episodes of <1/week (64%, 68%, and 63%, respectively) and postoperative UDI/IIQ questionnaire scores were similar (p > 0.2, all comparisons). Lower rates of patients achieving <1 episode of incontinence per week (50%; p = 0.07) and worse UDI/IIQ scores (p = 0.02) were associated with patients with > or =2 prior surgeries. Whereas results are similar following BAS in patients with or without varying degrees of ISD, worse outcomes are associated with prior surgery.

Recurrent Stress Urinary Incontinence After Dislodged Screws in Patient With Bone-Anchored Suburethral Sling

This is the first reported case of recurrent stress urinary incontinence secondary to dislodged bone-anchoring screws. A 71-year-old man who had undergone successful bone-anchored sling placement for post-prostatectomy incontinence, presented with recurrent stress urinary incontinence after a bout of coughing. Pelvic radiography revealed three screws had been dislodged. The mesh was left in place, with replacement of the dislodged screws and the addition of one extra screw. The findings of this case suggest that dislodged screws can be a possible cause of sling failure. Preoperative bone scanning and postoperative pelvic radiography should be a part of the routine workup for patients with bone-anchored slings.

Neue Verfahren zur operativen Therapie der postoperativen Belastungsinkontinenz beim Mann

The impact of minimally invasive techniques for the treatment of postoperative male incontinence has significantly improved in recent years. These techniques are based on the continuous increase in urethral resistance. This resistance can be readjusted with balloons placed paraurethrally or with readjustable suburethral slings. The success rates depend on the preoperative degree of incontinence. With bulking agents that are transurethrally injected into the submucosa of the sphincter, continence rates between 12 and 90% can be seen. Severe complications are rare. The impact of the studies is often limited due to a short follow-up. After implantation of adjustable balloons that are placed paraurethrally close to the bladder neck, continence rates up to 70% can be seen. The overall improvement of incontinence is observed in up to 90% of the treated patients. Complications such as balloon migration or mechanical disorders can cause operative revision. Suburethral sling systems are available as bone-anchored slings or as readjustable slings. Continence can be seen in up to 90% of the patients postoperatively. Severe complications such as sling erosion or sling infection are rare. In cases of mild and moderate incontinence, these minimally invasive techniques are good alternatives to the fascial sling or alloplastic sphincter implantation. To improve the evaluation and to compare these techniques with the conventional methods, further investigations with a longer follow-up are necessary.

The male perineal sling—a viable alternative to the artificial urinary sphincter

This Viewpoint provides a timely review of the current status of surgical treatments for men who develop stress urinary incontinence after radical prostatectomy. The author discusses the safety and efficacy of the bone-anchored perineal sling, a procedure that has recently undergone several modifications and is arguably emerging as a viable alternative to the artificial urinary sphincter.