Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling.
OBJECTIVE
We retrospectively evaluated the safety, efficacy and patient satisfaction following the male sling procedure for stress urinary incontinence.


METHODS
Forty-six patients, with a median age of 67 years, underwent the perineal male sling procedure for stress urinary incontinence. Radical retropubic prostatectomy was the commonest etiology of SUI. The male sling was placed over the bulbar urethra, through a perineal incision and anchored with the help of bone screws inserted in the pubic rami. Efficacy and treatment satisfaction were evaluated with the help of the validated UCLA/RAND questionnaire and questions addressing treatment satisfaction. Patients were defined as "cured" if they were dry or "improved" if utilizing 1-2 pads per day (based on response to question 1 of the UCLA/RAND questionnaire. Responses to questions 4 and 5 of the UCLA/RAND were utilized to determine the impact of the procedure on urinary leakage and urinary function postoperatively. Complications if any were noted.


RESULTS
One patient developed infection and two developed short-lasting perineal/buttock pain. Significantly, no patient developed urethral erosion. At a mean follow-up of 24 months, 34 patients were either dry (17/46, 37%) or utilizing only 1-2 pads per day (17/46, 37%), giving a cure/improvement rate of 74%. On evaluating the response to questions 4 and 5 of the UCLA/RAND questionnaire, 72% patients stated that urinary leakage and function were a "small to no problem". Moreover, 59% patients were moderately or completely satisfied with the procedure and 11% stated they were halfway satisfied with the procedure giving an overall satisfaction of 70%. A similar percentage felt that the treatment halfway or completely met their expectations.


CONCLUSIONS
At a mean follow-up of 24 months, the male sling procedure appears to be effective in the management of male SUI with a success rate of 74%. Moreover, it is safe as evidenced by the absence of any major complications such as urethral erosion. Finally, it is associated with a 70% patient satisfaction.
Rajpurkar
Atul D
AD
Department of Urology, Wayne State University School of Medicine, 4160 John R., Suite 1017, Detroit, MI 48201, USA.
Onur
Rahmi
R
Singla
Ajay
A
D000368:Aged; D001863:Bone Screws; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010384:Pelvic Bones; D010502:Perineum; D011468:Prostatectomy / Q000009:adverse effects; D012189:Retrospective Studies; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*