The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI).
Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed.
Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months.
We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
Urologia internationalis. 2020 Jun 15 [Epub ahead of print]
Markus Grabbert, Tanja Hüsch, Alexander Kretschmer, Ruth Kirschner-Hermanns, Ralf Anding, Bernhard Brehmer, Carsten Maik Naumann, Fabian Queissert, Hagen Loertzer, Wael Khoder, Christian Gratzke, Torben Hofmann, Wilhelm Huebner, Axel Haferkamp, Ricarda M Bauer
Department of Urology, University Hospital Freiburg, Freiburg, Germany, ., Department of Urology, University Medical Center Mainz, Mainz, Germany., Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany., Department of Neurourology, University Hospital Bonn, Bonn, Germany., Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany., Department of Urology, Marienhaus Hospital Neuwied, Neuwied, Germany., Department of Urology, University Hospital Münster, Münster, Germany., Department of Urology, Westpfalz Hospital Kaiserslautern, Kaiserslautern, Germany., Department of Urology, University Hospital Freiburg, Freiburg, Germany., Department of Urology, Korneuburg General Hospital, Korneuburg, Austria.