Male slings are not tension-free, a primary stable fixation is critical for success.[1] With barbed hooks the continence rates of AdVanceXP® (Boston Scientific) increased from 58.6% to 90.3% after one year. Various techniques have been developed like sling tunneling, crossing, or suture fixation, often with local discomfort or pain. We applied a novel fixation technique to a male transobturator sling (DynaMesh-PRM visible) to secure stability particularly in the early postoperative phase.

DynaMesh®-PRM visible is made of PVDF (monofilament polyvinylidene fluoride) with integrated iron particles that provide MRI visiblity. We used a single-incision technique and synthetic cyanoacrylate surgical glue (Glubran® 2, Dahlhausen) to affix the tape to the lower branches of the pubic bone. 14 Patients (median age 67.3 years) with mild to severe stress urinary incontinence were treated from 11/2015 to 12/2019. Patient characteristics, patient reported outcomes, and complications were recorded. Moreover, MRI studies were conducted in selected patients to visualize the sling.

The surgical glue sling fixation technique was easily and safely feasible in all patients. After a median follow-up of 12.5 months 8/14 (57.1%) patients were dry, 5/14 (35.7%) reported significant improvement, and 1 patient (7.1%) showed no improvement. We observed 1 transient hematuria (7.1%), but no signs of inflammatory reaction and no major complications. Local pain in the perineal region occurred in 6/14 patients (42.9%), in 2 of them (14.3%) extending beyond the early postoperative phase. 4/14 patients (28.6%) reported de novo dysuria, 1 patient (7.1%) de novo urge incontinence. In the MRI studies the mesh structure, the course of the tape, and the relocation of the urethral bulb were well visualized.

This cohort of patients is not preselected but reflects everyday practice of male incontinence surgery. 4/14 (28.6%) patients had a history of prostate radiation therapy, 2/14 (14.3%) patients who belonged to the severe incontinence group had a neurogenic component. With adequate preoperative testing (cystoscopic urethral sphincter evaluation with repositioning test) these patients also qualify for transobturator sling placement. Therefore an overall improvement rate of 92.8% is a favorable result in this heterogenous group of patients without excluding unfavorable preconditions.

With surgical glue an immediate and stable sling fixation could be achieved. The overall improvement rate was 92.8%. We observed no inferiority of our results in comparison to the most frequently used sling (AdVance®) in this case series. This novel fixation technique and the innovative PVDF sling facilitate this male incontinence procedure, make it more reliable, and show promising results. The visible mesh technology is an important step forward to illustrate the mode of action of male slings and offers the opportunity to visualize possible failures and complications.

De Ridder D, Rehder P.  The AdVance Male Sling: Anatomic Features in Relation to Mode of Action. Eur Urol Suppl 2011;10(4):383-389