Rigi10™ Malleable Penile Prosthesis
Also Known As
Male urethral sling, suburethral sling, perineal sling, transobturator male sling, retropubic male sling, male incontinence sling
Definition
A male sling is a surgical procedure used to treat male stress urinary incontinence (SUI) by providing support to the urethra.¹ The procedure involves placing a synthetic mesh or strip beneath the bulbar urethra, creating compression and repositioning the proximal urethra.² This supportive mechanism resembles a hammock, exerting pressure on the bulbous urethra to prevent urine leakage during activities that increase intra-abdominal pressure.³ Male slings act by enhancing urethral coaptation, effectively aligning the urethral sphincter complex and improving continence.⁴ The procedure can be performed using either transobturator or retropubic surgical approaches, with the goal of restoring urinary control in men with mild to moderate incontinence.⁵
Clinical Context
Male slings are primarily indicated for men with mild to moderate stress urinary incontinence, typically defined as using 0-2 pads per day or having a total pad weight of less than 500 grams in 24 hours.¹ They are particularly beneficial for patients with post-prostatectomy SUI who exhibit some degree of residual voluntary sphincter function but have not responded adequately to conservative management.²
Patient selection is crucial for optimal outcomes. Candidates should undergo comprehensive evaluation including medical history, physical examination, urinalysis, documentation of post-void residual, pad testing, urodynamics, and cystoscopy.³ The residual sphincteric function can be evaluated endoscopically during awake cystoscopy or through urodynamic studies.⁴ Patients must generate sufficient bladder pressure to overcome the urethral resistance produced by the sling.⁵
The procedure can be performed via transobturator or retropubic approaches. The transobturator approach involves a perineal incision to expose the bulbar urethra, with the sling arms passed through the obturator foramen on each side.⁶ The retropubic approach requires both perineal and abdominal incisions.⁷ Both techniques aim to position the sling beneath the urethra to provide appropriate compression and support.
Postoperative care typically includes catheterization for 24-48 hours, followed by a voiding trial. Most patients experience immediate improvement in continence, though some may require time for optimal results as tissue integration occurs.⁸ Success rates range from 40-90%, with better outcomes observed in patients with milder incontinence and no history of radiation therapy.⁹