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

Nature Clinical Practice Urology volume 3, pages 118–119 (2006)Cite this article

Screening and the early detection of prostate cancer have led to a dramatic increase in the number of men undergoing radical prostatectomy. As a consequence, stress urinary incontinence (SUI) is now more prevalent in men than it was in the past. Approximately 10% of patients seek treatment for incontinence following radical prostatectomy.1 Surgical intervention is indicated for men with bothersome SUI caused by sphincteric insufficiency, if incontinence fails to improve with conservative management. For more than 30 years, the artificial urinary sphincter (AUS) has been considered the most reliable treatment for men with SUI. The male perineal sling, however, has undergone significant modifications over the past decade, and has been established as an efficacious, less invasive alternative to the AUS. It also has several distinct advantages over the AUS.

The AUS relies on dynamic urethral compression to be successful. A fluid-filled, pressurized cuff is placed around the urethra, and is connected to a balloon reservoir and a scrotal pump. Fluid transfer from the cuff to the reservoir is accomplished by active pumping, thereby permitting voiding. Cuff refilling occurs via the pressure gradient from the reservoir, traversing a resistor implanted in the pump mechanism. The perineal sling, on the other hand, consists of a ventrally placed, suburethral sling, supported by bone-anchored sutures placed in the descending pubic rami, lateral and dorsal to the bulbous urethra. Urethral occlusion is adequate to prevent leakage, yet still permits normal voiding during a coordinated bladder contraction.

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References

  1. Stanford JL et al. (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 283: 354–360

    Article  CAS  Google Scholar 

  2. Comiter CV (2005) The male perineal sling: intermediate-term results. Neurourol Urodyn 24: 648–653

    Article  Google Scholar 

  3. Dikranian AH et al. (2004) The male perineal sling: comparison of sling materials. J Urol 172: 608–610

    Article  CAS  Google Scholar 

  4. Madjar S et al. (2001) Bone anchored sling for the treatment of post-prostatectomy incontinence. J Urol 165: 72–76

    Article  CAS  Google Scholar 

  5. Rajpurkar AD et al. (2005) Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol 47: 237–242

    Article  Google Scholar 

  6. Elliott DS and Barrett DM (1998) Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol 159: 1206–1208

    Article  CAS  Google Scholar 

  7. Venn SN et al. (2000) The long-term outcome of artificial urinary sphincters. J Urol 164: 702–706

    Article  CAS  Google Scholar 

  8. Montague DK and Angermeier KW (2000) Postprostatectomy urinary incontinence: the case for artificial urinary sphincter implantation. Urology 55: 2–4

    Article  CAS  Google Scholar 

  9. Ullrich NF and Comiter CV (2004) The male sling for stress urinary incontinence: urodynamic and subjective assessment. J Urol 172: 204–206

    Article  Google Scholar 

  10. Castle EP et al. (2005) The male sling for post-prostatectomy incontinence: mean followup of 18 months. J Urol 173: 1657–1660

    Article  Google Scholar 

Download references

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  1. Associate Professor of Surgery and Urology, and Chief of the Section of Urology at the University of Arizona Health Sciences Center, Tucson, AZ, USA

    Craig V Comiter

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  1. Craig V Comiter
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Correspondence to Craig V Comiter.

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Meeting participant and lecturer for American Medical Systems.

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Comiter, C. The male perineal sling—a viable alternative to the artificial urinary sphincter. Nat Rev Urol 3, 118–119 (2006). https://doi.org/10.1038/ncpuro0429

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