Male Sling Procedure

What is a male sling procedure?

The male sling procedure is a minimally invasive surgical procedure to help treat males who can’t control their urinary bladder (urinary incontinence). A healthcare provider uses a soft, synthetic (human-made), mesh-like surgical tape around part of your urethral bulb (bulb of penis). The surgical tape elevates and reinforces your urethra (the tube through which pee leaves your body) and bladder neck. The bladder neck is the bottom of your bladder. It’s where pee enters your urethra before leaving your body.

The urethral bulb is a bulbous part of an internal chamber that runs along the bottom of your penis (corpus spongiosum) and surrounds your urethra. It’s near the base of your penis, between the two larger chambers that run the length of the top of your penis (corpora cavernosa). The urethral bulb helps you control when you pee, especially during exercise.

Other names for a male sling include:

• AdVance® sling
• Coloplast Virtue® male sling

What does it treat?

The male sling procedure helps males who develop incontinence after prostate surgery, especially if a surgeon removes your entire prostate (radical prostatectomy) to treat prostate cancer.

Healthcare providers generally recommend a male sling procedure if you have mild or moderate urinary incontinence — wetting one to three pads per day or fewer.

What tests are done before a male sling procedure?

Before a male sling procedure, a healthcare provider may order tests, including:

• Urodynamic testing. These tests help diagnose problems in your lower urinary tract. A provider may order them to test how well your nerves and muscles work, detect pressure in and around your bladder and determine how much you pee and how strong your urine stream is.
• 24-hour pad test. A 24-hour pad test identifies how many pads you use over 24 hours to control leaks and measures how much you leak.
• Cystoscopy. A provider uses a long, thin tube with a light and camera at the end to look inside your urethra and bladder.
• Electrocardiogram (EKG). An EKG helps determine how well your heart is working. A provider may order an EKG to ensure your heart can handle a male sling procedure.
• Blood tests. Blood tests can help your surgical team determine if you have a blood-clotting condition (such as hemophilia) that increases your risk of bleeding during the procedure.
• Urinalysis (urine test). During a urinalysis, providers examine your pee’s physical, chemical and microscopic components to check if you have any conditions (such as a urinary tract infection, kidney disease or diabetes) that could affect the procedure or your recovery.

How should I prepare for a male sling procedure?

Tell your healthcare provider if you’re taking any prescription or over-the-counter medications, including herbal supplements. Anticoagulants (blood thinners), nonsteroidal anti-inflammatory drugs (NSAIDs) and certain herbal supplements can increase your risk of bleeding. You may need to stop taking these medications for up to two weeks before surgery. You may take acetaminophen (Tylenol®) for headaches and mild pain if necessary. Unless otherwise specified by your provider, you can still take medications such as:

• Antibiotics
• Blood pressure medications
• Hormone pills
• Heart medications

A provider will also give you specific directions on what to eat before the procedure and when to stop eating and drinking. Most males should only eat or drink clear liquids the night before surgery. Clear liquids include anything you can see through, such as broth, juices and gelatin (Jell-O®). This helps keep your intestines (bowels) clean during surgery and reduces contamination and infection risks.

Only use a small sip of water if you must take medications the night before or the day of your male sling procedure.

What happens during the procedure?

A special team of healthcare providers performs a male sling procedure. The team typically includes:

• Anesthesiologist
• Nurses
• Urologist (surgeon)

The anesthesiologist will give you general anesthesia so you sleep through the procedure and don’t feel any pain.

Once you’re asleep, the urologist will:

• Make a cut (incision) through your perineal tissue (the area between your anus and scrotum)
• Expose your urethra
• Place surgical tape around the part of your urethral bulb that covers the uppermost part of the urethra, near the urethral sphincter (a muscle that acts as a sort of valve that opens and closes to remove pee from your body)

The surgical tape gently moves the urethra into a new position, increases resistance in the area and supports the bladder neck.

How long does it take?

Between anesthesia, prepping, the procedure itself and coming out of anesthesia, male sling surgery takes longer than an hour. This time can vary according to your tissue health and body shape.

What can I expect after a male sling procedure?

After a male sling procedure:

• A healthcare provider will stitch your incision closed and cover it with bandages.
• The anesthesiologist will stop putting anesthesia into your body. You’ll be conscious (awake) within a few minutes. But you’ll likely still feel groggy.
• You’ll move to a recovery room. Providers will wait for you to wake up more fully and track your overall health. They’ll also treat your pain.

The male sling procedure is usually an outpatient procedure. That means you can go home on the same day as the procedure. But in some cases, you may need to stay in the hospital overnight. They’ll let you go home (discharge you) once they determine you no longer require monitoring.

How do you pee after a bladder sling?

You may need a urinary catheter if you can’t pee as usual immediately after the procedure. A urinary catheter drains pee from your bladder. You may need to use a catheter for a few days because swelling may make it difficult to pee. After the swelling goes down, you’ll be able to pee on your own.

After you recover, you should be able to pee normally after a male sling procedure.

What are the benefits of a male sling procedure?

The male sling procedure’s main benefit is treating urinary incontinence. Other benefits of the procedure include:

• The procedure only requiring a small incision in your perineum
• Minimum scarring
• Short recovery time
• The male sling being entirely inside your body, so you can’t see it

How long does the male sling last?

The male sling should last between 10 and 15 years.

How successful is the surgery?

The male sling procedure is very successful. Recent studies show that nearly 80% of males who get a male sling procedure have no (or greatly improved) incontinence symptoms.

What are the side effects?

Male sling procedure complications are rare. But all types of surgery for urinary incontinence have potential risks. Some possible side effects of a male bladder sling include:

• Inability to pee (urinary retention), which is the most common problem after surgery and may require you to use a catheter for another few weeks (in rare cases, you may need a second surgical procedure to correct urinary retention)
• Bleeding
• Infection
• The surgical tape starting to erode into your urethra
• Urinary incontinence coming back (recurrent incontinence)
• Urinary tract infection (UTI)
• New or worsening overactive bladder symptoms, including peeing more often (urinary frequency), sudden urges to pee (urinary urgency) and waking up in the middle of the night more often to pee (nocturia)

What is the recovery time after a male sling procedure?

It depends. Your body is unique, and how you respond to a male sling procedure may be different from others. Most start to feel better within a week. But it may take longer. You may also need to use a catheter until the swelling goes away. Your typical peeing patterns may also take a few weeks to return to normal. Talk to your urologist. They’ll give you a better idea of what to expect as you recover.

When can I go back to work/school?

It depends. Most males can return to school or desk work a few days after a male sling procedure. But you may need to rest longer if you have a more physically demanding job that involves vigorous activities or heavy lifting. Talk to your surgeon for individual recommendations.

When can I have sex?

Ask your healthcare provider when it’s safe to have sexual intercourse after a male sling procedure.

When should I call a healthcare provider?

Call a healthcare provider if you:

• Can’t pee
• Have blood in your pee (hematuria)
• Have signs of infection, including fever, chills or swollen testicles

You should also talk to a provider if you don’t get your desired results or if leakage returns later. They can discuss any additional procedures you may need and work with you to develop the best treatment plan.