AdVance Male Sling
The AdVance Male Sling is performed by Dr. Engel primarily for post-prostatectomy incontinence. Success rates (no more pad usage) have been well above 90%, less if the patient has been radiated, but emphasis must be placed on patient selection. A Male Sling is really only appropriate for patients that use only one or two incontinence pads per day. For more severe male urinary incontinence, the artificial urinary sphincter is placed.
AdVance Male Sling
A: Perineal incision. B: Dissection of bulbar urethra. C: Insertion of left obturator needle.
D: Attachment of sling to needle. E: Attachment of sling to urethra. F: Sling ready to be tightened.
A: Bladder neck before tightening. B: Bladder neck after tightening.
In Dr. Engel’s hands, the AdVance Male Sling is performed in an outpatient surgical center setting in approximately one hour. As the figures above and the video below shows, the sling is placed by exposing the bulbar urethra, or the urethra between the anus and scrotum via a small incision. Punctures are made at the inner thigh on both sides, and special needles are passed from here to the urethra to place the sling. The sling is attached to the urethra but nothing else, and it is for this reason that patients must refrain from strenuous activity or leg stretches for six weeks to avoid loosening the sling before it has healed in place. Patients will go home with a small urinary catheter, but they will remove the catheter themselves early in the morning the next day and see Dr. Engel 6-8 hours later in the office. Continence is immediate. Occasionally, the catheter must be replaced for a few days until the bladder acclimates to the newfound resistance to flow generated by the sling.
Patients will usually have mild to moderate discomfort in their perineum that lasts typically a week or so. Possible complications of an AdVance male sling include bleeding or infection. Leg pain from the needle passage is extremely rare but has been reported, and urethral erosion from the mesh material is likewise extremely rare, but possible. Patients are made aware that technically an AdVance Male Sling is “pelvic mesh”, but are reassured that this mesh is not the subject of class action lawsuits that have been so prevalent with regards to older female incontinence procedures. Regardless, all patients must assume this very small risk of using mesh material in this operation. Patients will typically be asked to begin a course of antibiotics a few days before the procedure to keep infection risk as low as possible.