The male sling for post-radical prostatectomy urinary incontinence: urethral compression versus urethral relocation or what is next?

SummaryMale stress urinary incontinence is a common complication after prostatic surgery which can have a devastating effect on a patient's quality of life. Treatment can be difficult. If conservative management fails surgical options are available. The latter include the more recently developed male sling procedures which offer encouraging short- and medium-term efficacy and safety. Male slings offer a less invasive and less expensive treatment option compared to the artificial urinary sphincters and allow spontaneous voiding. Success is associated with careful patient selection with higher success rates seen in lower incontinence degrees. A number of innovative developments, products and techniques have led to the emergence of fundamental differences in the surgical mechanism of correcting sphincteric weakness. Male sling devices appear to be following two entirely different technical principles, i.e. compression of the urethra versus relocation of the urethral bulb. There is little doubt that materials and surgical techniques will continue to evolve and the male sling may increasingly become a treatment option in the management of male stress incontinence. However, further objective evaluation and restricted introduction in specialised units are required.