Stress urinary incontinence (SUI) in men is usually secondary to prostatectomy or neurological lesions. We present treatment results of male suburethral sling for male SUI.

Patients with post-prostatectomy incontinence (PPI, n=47) and neurogenic lesion causing urethral sphincter insufficiency (NSUI, n=20) were treated with a suburethral sling procedure using a polypropylene mesh and a cardiovascular patch. In PPI patients, retrograde leak point pressure (RLPP) was set at 50-60 cmH2O, and in NSUI patients, the RLPP was adjusted to no urine leakage without interfering catheterization. The treatment outcome was defined as successful if the patient achieved either complete continence or social continence (≤1 pad/day) at 3-month follow up. The revision rate and the infection rate were also assessed.

The mean age of the cohort was 63.9 ± 16.5 years, with a mean follow-up period of 40.1 ± 48.7 months. The overall success rate was 56.7%, 57.4% in PPI and 55% in NSUI group (p = 1.000). PPI patients without radiotherapy had a higher success rate of 63% compared to 33% in patients with prior radiotherapy (p = 0.363). The analysis of variables revealed in successful patients revealed that PPI patients had a higher BMI, while NSUI patients had a higher corrected Qmax, bladder contractility index, and RLPP. No significant difference was noted in baseline abdominal LPP between groups. Six (8.9%) patients required a second surgery for sling enhancement, 7 (10.4%) underwent sling tension release procedure, and 4 (5.9%) experienced wound infections necessitating sling removal.

The suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is safe and effective for male SUI. The success rate was 56.7% in a mean follow-up period of 40 months. While radiotherapy reduced success rates, intraoperative RLPP measurement enabled effective tension adjustment, particularly in NSUI cases.