Investig Clin Urol.  2016 Jan;57(1):3-13. 10.4111/icu.2016.57.1.3.

The artificial urinary sphincter and male sling for postprostatectomy incontinence: Which patient should get which procedure?

• Comiter CV
• Dobberfuhl AD

• KMID: 2363119
• DOI: http://doi.org/10.4111/icu.2016.57.1.3

Abstract

Surgery is the most efficacious treatment for postprostatectomy incontinence. The ideal surgical approach depends on a variety of patient factors including history of prior incontinence surgery or radiation treatment, bladder contractility, severity of leakage, and patient expectations. Most patients choose to avoid a mechanical device, opting for the male sling over the artificial urinary sphincter. The modern male sling has continued to evolve with respect to device design and surgical technique. Various types of slings address sphincteric incompetence via different mechanisms of action. The recommended surgery, however, must be individualized to the patient based on degree of incontinence, detrusor contractility, and urethral compliance. A thorough urodynamic evaluation is indicated for the majority of patients, and the recommendation for an artificial urinary sphincter, a transobturator sling, or a quadratic sling will depend on urodynamic findings and the patient's particular preference. As advancements in this field evolve, and our understanding of the pathophysiology of incontinence and mechanisms of various devices improves, we expect to see continued evolution in device design.

Keyword

Artificial urinary sphincter; Prostatectomy; Stress urinary incontinence; Suburethral slings; Urodynamics

MeSH Terms

Equipment Design
Humans
Male
Patient Selection
Prostatectomy/*adverse effects
*Suburethral Slings
Urinary Incontinence/etiology/physiopathology/*surgery
*Urinary Sphincter, Artificial
Urodynamics

Figure

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  Fig. 1 Transobturator sling. Upon tensioning, the bulbar urethra will move proximally.

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  Fig. 2 (A) The quadratic sling is identified and readily dissected off the urethra. (B) After incising the sling, the bulbospongiosus is exposed, thus permitting a straightforward artificial urinary sphincter placement.

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