A new transobturator sling offers relief for men with mild to moderate stress urinary incontinence (SUI) that often occurs following prostate surgery. Urology PC recently began implantation of the new Coloplast Virtue® sub-urethral sling, which provides significant advances over previous male incontinence treatments.
It is not uncommon for men who undergo prostate cancer surgery of any type to experience some degree of transient urinary incontinence. In the vast majority of these patients, this problem resolves over time with non-invasive treatments such as pelvic floor exercises (Kegels).
However, a small percentage of the patients (5-15%) will not improve to a satisfactory degree and may require surgical management. The traditional standard for the treatment of severe urinary incontinence after a prostate surgery remains placement of a multi-component Artificial Urinary Sphincter (AUS). However, male slings now offer a less invasive option for many patients with mild-to-moderate urinary incontinence that is bothersome, but not severe enough to need the AUS, or when a patient opts not to explore a more invasive mechanical option. The Virtue treatment is easier for the patients as there are no mechanical aspects to manipulate each time the patient wants to urinate. In fact, a recent study demonstrated that when patients were informed by their doctors that they were candidates for either the AUS or a male sling, the vast majority (92%) chose the male sling as a first option.
The two main types of male slings currently available are the bone-anchor and transobturator slings. The new Virtue transobturator male sling provides a series of improvements over previous versions of transobturator slings. Virtue offers an easier method for the transobturator sling placement for the surgeon. In addition to the two transobturator arms common in other slings, the Virtue also has two pre-pubic arms that allow for greater coverage and direct positioning of this sling over the appropriate area of the urethra, perhaps increasing success. The four-arms of Virtue not only lift the urethra, but also compress it, providing greater stability and bladder control. This proprietary quadratic fixation also minimizes the chance for post-operative movement or migration of the sling that has been commonly considered in the failure of previous transobturator slings. Moreover, the Virtue male sling may not hinder or preclude the possibility of placement of an AUS in the future, should the need arise.
Virtue is an option for men whose SUI is not responsive to non-surgical therapies and whose urinary incontinence is determined to be mild to moderate after the appropriate evaluation by their urologist. The two main factors that determine success of this procedure are (1) Proper patient selection and (2) Establishing realistic expectations for the patient.
Both of the points are the responsibility of the physician. There is a low complication rate with the sling procedure, but each individual patient must decide (after a thorough discussion with his urologist) if the benefits of surgery outweigh the risks. The majority of the time with male slings that answer is ‘yes.’
Lance Wiebusch, MD