Tuesday, 17 March 2015

Surgery for stress incontinence: Male tapes

Male tapes


Many tapes are available in the market. Probably the most common are


  • AdVance male sling (AMS)
    • Mild to moderate SUI (3-4 pads per day)
    • Success rates at 1y are 60-80%
  • InVance male sling (AMS)
    • Success rates 70-80% at 3-4y 

Artificial urinary sphincter 

  • Inflatable cuff
  • Pressure regulating baloon
    • Balloon pressure  61-70 mmHg (bulbar urethral placement)
    • Balloon pressure 71-80 mm Hg (bladder neck placement)
  • Activating pump
  • Indications: 
    • Moderate to severe SUI 
    • Normal bladder capacity and compliance 
    • In men after: RP, Rx, pelvic fracture, complicated urethral reconstruction 
    • In women: failure of other treatments for incontinence
    • In both sexes for neuropathic sphincter weakness (e.g. SCI, spina bifida) 
  • Contraindications:
    • Bladder neck stenosis
    • Poor manual dexterity or cognition 
    • Active infection
    • If OAB and ISD treat OAB first
  • Success: long term is 70-90% 
  • Revision rates: 20-30% 
  • Complications 
    • Urethral atrophy (10%)
    • Mechanical failure 
    • Urethral erosion (5%)
    • Infection (1-5%)
    • Bladder overactivity or reduced compliance 

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