Tuesday, September 27, 2022

Sling Procedure For Male Urinary Incontinence

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What Is A Male Sling For Men With Sui

New Procedure for Urinary Incontinence

A male sling is a minimally invasive implantable device used to treat mild to moderate male stress urinary incontinence after prostatectomy.

Male slings are thought to treat male stress urinary incontinence by a combination of dynamic compression of the urethra as well as repositioning of the section of urethra located just below the bladder.

Male slings are a minimally invasive surgery using a passive mechanism to treat male stress urinary incontinence i.e. there is no device manipulation as occurs with the artificial urinary sphincter .

Like the material used in female slings to treat stress urinary incontinence , male slings are made of a small strip of medical mesh similar to the material used in other surgery such as hernia repairs. The urethral sling material remains in the body permanently . The sling is placed under the urethra and exits through small incisions in the skin .

The hospital stay is short with a fast recovery time after sling surgery although patients must avoid strenuous activity for 6 weeks after surgery to allow the sling to fix in position with scarring. The effects of surgery are immediate.

What Is A Male Bladder Sling

A male bladder sling or male urethral sling is a surgical treatment for incontinence in men. It is common in stress incontinence but can improve the symptoms of other types.

After placing a male bladder sling, no manual skill or training is required. It works mechanically as a hammock that brings up the urethra and applies gentle pressure. Since it works by itself and does not have complex mechanical parts, patients usually have rapid results .

There are two male bladder sling options available at the moment. One of them is Boston Scientifics AdVance Male Sling System, and the other is Coloplasts Virtue sling. The former uses two arms to do the job, and the latter uses four arms. In the past, there was also a three-arm sling available, the Argus sling.

How Is The Male Sling Procedure Done

During the male sling procedure, an incision is made through the perineal tissue . The surgeon will then expose the urethra and use a supportive sling around part of the urethral bulb that covers the most upper part of the urethra close to where it enters the area of the urethral sphincter. By wrapping the surgical tape around the urethral bulb, the sling gently moves the urethra into a new position and increases resistance in this area. This lends support to the bladder neck. This procedure has been shown to help with mild to moderate urinary incontinence, and is most commonly used after radical prostatectomy.

The male sling procedure is usually performed as an outpatient surgery. However, there are some cases where patients will need to stay in the hospital overnight after surgery. The sling support requires absorbable sutures in the perineum . This may cause some pain right after surgery, but overall, the amount of pain is usually mild and well tolerated.

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How Long Will It Take Me To Get Back To My Daily Activities

The doctor will generally remove the catheter within 24 hours after the surgery and monitor your recovery. Usually, you can leave the hospital a few days after the procedure. If you have problems urinating or there is much post-void residual urine in the bladder, you may have to stay longer. The recommended length of hospital stay varies in different countries.

After any surgery, your body needs time to fully recover. It can take up to 6 weeks for the wound to completely heal. During this time you may experience pain in the pelvic area, or feel pain when you urinate. Your doctor can prescribe medication to deal with these symptoms.

Your wound will be checked as well. Usually, stitches that dissolve and disappear are used.

During the recovery period your doctor may recommend to:

  • Consume enough liquid, especially water, to provide at least 2 litres of urine output
  • Do not lift anything heavier than 5 kilograms
  • Do not do any heavy exercise
  • Take showers instead of baths
  • Avoid thermal baths, or going to the sauna
  • Prevent constipation by adapting your diet
  • Avoid sexual activity
  • Avoid activities which can traumatise the operation site, such as cycling and horseback riding.
  • Have a fever

Evidence For Surgical Management For Men With Urinary Incontinence After Prostate Surgery

Urinary Incontinence: Not Just a Flow Issue

We have analysed long-term follow-up data from men approached for the Men After Prostate Surgery trial and found that around 70% of men still reported some urine leakage 4 to 6 years after a radical prostatectomy , and 39% after a transurethral resection of prostate . Of this cohort, 25% and 5% of men respectively were using pads, and 8% and 2% had leakage several times a day of a moderate or large amount of urine. A further 15 men had already had an AUS operation , and six a male sling . In addition to these, a further 5% and 3% of men were considering surgery for incontinence.

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Advantages And Disadvantages Of The Transobturator Retrourethral Sling

Of the transobturator retrourethral sling devices, most studies reported on the AdVance sling, which has relatively good outcomes. In particular, good results can be expected in patients who have good residual sphincter function and those who have mild-to-moderate PPI. Overall, relatively few complications occur and most of them are mild.

One disadvantage is that adjustment is impossible after surgery, and the success rate of the surgery may not be good in patients who previously had radiation treatment, those with severe PPI, or those who have a defect in the sphincter function.

Coloplast Virtue Male Sling

A minimally invasive treatment designed for mild or severe SUI in male patients. Combining technologically advanced design, construction, and materials, Virtue® offers a potentially safer, more effective treatment solution than other male slings and possibly artificial urinary sphincters. Virtue® is a permanent solution. Virtue® is the only male sling that utilizes a four-arm approach that uses both elevation and compression to alleviate stress urinary incontinence. A polypropylene mesh material is implanted underneath the bulbous urethra to elevate and apply a gentle compression to prevent urine leakage.

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What Was The Male Sling Developed For

The bladder sling procedure in males was developed as a surgical treatment for certain types of urinary incontinence. This surgery works in males who suffer from bothersome but not severe symptoms.

These patients usually have mild or moderate incontinence problems. It mainly works successfully in cases of sphincter deficiency. In other words, when the ring-like muscle that keeps the urine in the bladder is no longer working as it should.

These patients typically have stress urinary incontinence and small leaks of urine. Instead of fixing the sphincter muscle, the male sling procedure is a type of extra source of grip. It is placed near the weak area, slightly lifting the urethra and providing support.

It does have a mechanical effect by pressing on the site against the bladder. Thus, it contributes to the urethra sphincter to keep the urine inside the bladder. As such, it is an appropriate measure for cases when the sphincter is the source of the incontinence problem .

It is not developed and not appropriate for:

  • Patients with severe symptoms of incontinence
  • Patients with vesicoureteral reflux and other conditions that may compromise the kidney function
  • People with a compromise in the bladder neck or urethral tissue.
  • Patients with an ongoing urinary tract infection

What Does The Procedure Involve

Innovative Incontinence Surgery: The Male Sling

The male sling is a treatment for male stress urinary incontinence. It involves placement of a synthetic sling that supports the waterpipe . The procedure will involve a cystoscopic examination of the urethra and bladder and an incision in the area behind the scrotum , with two further small cuts in the groin crease.

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How Do I Prepare For Surgery

  • Your surgeon will talk to you about how to prepare. He or she may tell you not to eat or drink anything after midnight on the day of your surgery. Arrange to have someone drive you home when you are discharged. You may need to stay overnight in the hospital.
  • Tell your surgeon about all your current medicines. He or she will tell you if you need to stop any medicine for surgery, and when to stop. He or she will tell you which medicines to take or not take on the day of your surgery.
  • Tell your surgeon about any allergies you have, including to medicines or anesthesia. You may be given an antibiotic to help prevent a bacterial infection.

What Is A Male Sling Procedure

Urinary incontinence in men is common enough that there have been many methods of control developed. Adult diapers and various medications have been utilized by men suffering from all types of urinary incontinence. And if you are suffering from the same condition, it is safe to assume that you have considered these temporary solutions as a way to deal with your condition. But a procedure known as a male sling procedure could be the key to regaining your control permanently.

But what is a male sling procedure? How does it work? And what are the chances it can help you? OurSouth Florida urology specialists, with experience in all things urology from erectile dysfunction to silicone penis enlargement, are ready to answer these questions for you. But first, lets review the condition that started this search for treatment.

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What Will I Experience During The Recovery Process

Every patient is different, but most men expect a quick recovery time. A majority of our patients resume normal activities 1-2 weeks after the procedure and full activity can be resumed in 6 weeks. Complications are rare, but they include pain and inflammation, urinary retention, urethral or tissue damage and bleeding and irritation at the site of the wound.

What Happens Before The Male Sling Procedure

Urinary Sling Surgery

Before surgery, you may be asked to see your family physician or anesthesiologist for a preoperative checkup. If necessary, your doctor will do a few tests. These tests could include:

  • Urine tests

You may also be asked to follow a few rules before surgery. These include:

  • Do not take Aspirin or any blood thinning medications two weeks before surgery. This includes medications such as ibuprofen naproxen and clopidogrel . If necessary, you can take Tylenol® for headaches or pain. Any other medication such as antibiotics, high blood pressure medications, hormone pills, and heart medications should be continued unless otherwise specified.
  • Only consume clear liquids the night before surgery. This means anything you can see through, such as broth, juices and Jell-O. This helps keep the bowel clean at the time of surgery and reduces the risks of contamination.
  • Do not eat or drink anything after midnight the day before surgery. Any medication that must be taken the morning of surgery should be taken with a small sip of water.

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Scale Of The Problem In The Uk And Use Of Nhs Resources

Men undergoing radical prostatectomy for prostate cancer frequently report the troublesome symptom of stress urinary incontinence . Prevalence estimates vary widely between 5% and 57% depending on definition, timing of assessment after surgery, and population characteristics. The rate of recovery of continence plateaus at around 12 months after surgery. This was confirmed in a recent large HTA-funded RCT of pelvic-floor muscle training in patients who suffered incontinence 6 weeks after radical prostatectomy. Subsequently, 40% had persistent UI at 1 year, with half of these having severe UI needing containment which then did not improve further during the second 12 months up to 24 months after the original surgery .

This means that of the 6000 patients currently undergoing radical prostatectomy in the UK each year, 1200 will be using additional treatments for resultant stress incontinence beyond 12 months. UI has a major impact on quality of life, including profound loss of self-esteem together with restrictions on work, social interaction and personal relationships including sexual life. The utility value associated with a person with UI is 0.72 compared to 0.93 in a comparable age-matched population . This is particularly devastating for men undergoing radical prostatectomy since they were typically without any urinary problems prior to the surgery, are fit for their age, and have a long life expectancy having generally been cured of their prostate cancer.

Conservative Treatment Options For Men With Sui

Men with stress urinary incontinence can benefit from non-surgical treatment options including:

  • Correcting problems that cause chronic constipation and coughing
  • Cutting out smoking
  • Continence devices and aids
  • Advice regarding the appropriate choice of continence aids can be provided through specialist Urology Nurses and specialist Continence Advisors.
  • Options may include the use of pads and condom drainage .

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What Will Happen During Surgery

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the surgery area. With local anesthesia, you may still feel pressure or pushing during surgery, but you should not feel pain.
  • Your surgeon will make an incision in your perineum. This is the area between your scrotum and anus. He or she will place the sling under your urethra. The sling may have 2 ends or 4 ends. The ends may be stitched to your abdominal wall and your groin. Your surgeon will pull on the ends. This creates tension on your urethra that will help control urine. Tension may also help change the position of your urethra to keep your bladder from pressing on your urethra. Your surgeon may make other incisions in your lower abdomen to place a device to make adjustments to the sling later.
  • Your surgeon will check for correct placement of the sling. A Foley catheter may be placed to help you urinate until swelling from surgery goes away. The incision may be closed with absorbable stitches or medical glue.

Prior To Incontinence Surgery Patients Should Learn About The Sui Procedures And Ask Their Doctor Questions

Sling for Urinary Incontinence after Prostate Surgery

Men should know that the procedures used to treat SUI have been available for many years, that they are very successful and can be life altering in a positive way. However, it is also important that a patient realizes that after the procedure, he may not have complete bladder control with no leakage. Through working with my patients, it has been my observation that the male sling and artificial sphincter can be overcome if the bladder is allowed to be filled fully. Put another way, a man may need to continue to plan bathroom breaks and wear a pad for security because leaks are still possible or even could be expected if he waits too long to void his bladder.

Men should know that the procedures used to treat SUI have been available for many years, that they are very successful and can be life altering in a positive way.

Men are often embarrassed to discuss their incontinence, but there are successful treatments available. Urologists specializing in male continence restoration are accustomed to treating patients who drip or leak upon movement we are comfortable talking about the details.

Here is a list of questions to ask your doctor about stress incontinence procedures and devices:

  • Will I be completely dry? If not, how improved will I be?
  • Is there an alternative option that is not surgery?
  • How will radiation therapy affect my outcomes?
  • Will I need to stay overnight in the hospital?
  • Will I have a foley catheter after surgery?
  • What is the risk of infection of the device?
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    Surgical Treatment Options For Men With Sui

    Before considering surgery, a full assessment of stress incontinence should be made to determine an individuals suitability for surgery and make a recommendation regarding type of surgery. Such assessment may include:

    Overall the artificial urinary sphincter is regarded as the gold standard treatment for severe male stress urinary incontinence occurring after radical prostatectomy surgery. Slings, injectable agents and other devices are better suited to men experiencing mild to moderate stress incontinence.

    What Happens After The Procedure

    After the procedure you may stay in a recovery area for at least a few hours or overnight at the hospital.

    You may go home with a catheter, which is a small tube used to drain urine from your bladder. Your healthcare provider will tell you how to take care of the catheter and when it can be removed.

    You may have some pain after the procedure. Your healthcare provider may give you pain medicine.

    Ask your healthcare provider:

    • How long it will take to recover
    • What activities you should avoid and when you can return to your normal activities
    • How to take care of yourself at home
    • What symptoms or problems you should watch for and what to do if you have them

    Make sure you know when you should come back for a checkup.

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    Is This The Right Urology Surgery For You

    What is a male sling procedure? It can be simplified as follows: a tape that is similar to mesh in consistency and texture is placed in a problem area of the urethra. This action allows for the urethra to move into a new place, a new place that grants the patient control over their bladder once again. If it seems straightforward, its because it is.

    A male sling procedure typically takes roughly 90 minutes to complete, and it is recommended that about 60 days be taken to fully recover with no strenuous activities like weightlifting occurring during that time period. The success rate for this procedure is said to range between 70-80%. Be sure to maximize the chances of success by going to a urology clinic that specializes in all types of male urology surgery.

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