EURURO Vol. 72 No. 3

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Urethral injections of bulking agents have been advo-
cated, but no existing evidence indicates that bulking agents
cure postprostatectomy incontinence. There is weak evi-
dence that bulking agents can offer temporary improve-
ment of incontinence and in quality of life in men with
postprostatectomy incontinence .
The AUS is considered to be the standard of care for men
with moderate to severe SUI; however, the quantity and
level of evidence for effectiveness is low with no well-
designed prospective RCTs. Nonrandomised cohort studies
suggest that primary AUS implantation is effective for cure
and improvement of SUI in men, but may be less effective
for men who have had pelvic radiotherapy and associated
with higher morbidity such as erosion.
5.1. Male synthetic mesh sling
Slings tapes are positioned under the bulbar urethra, and
fixed by a retropubic or TO approach. Possible risks include
voiding dysfunction, device erosion, and chronic pain ,
although these are significantly lower in comparison with
women.
There is no evidence that adjustability of male sling
systems offers an additional benefit over other types of male
slings, but may require multiple adjustments Possible
complications include voiding dysfunction, device erosion,
chronic pain (more often compared with fixed male
synthetic mesh slings), infection, and explantation due to
infection and chronic pain.
5.2. Consensus view
Synthetic male slings are accepted as an effective therapy,
with expert opinion suggesting that they are most
appropriately directed at the treatment of men with milder
forms of stress incontinence, with AUS implantation being
more appropriately used in patients with all degrees of
severity, but more so in more severely symptomatic
patients. There is an absence of adequate randomised
controlled studies looking at surgical treatment, and further
comments on efficacy await the results of such work, such
as the MASTER trial in the UK which has so far recruited over
270 men of the 360 required . Synthetic slings using
existing material are reported to be associated with
postoperative discomfort in up to 10% of patients with a
low incidence of infection and mesh exposure. This is
considered to be an acceptable therapy in contemporary
practice. Patients should be adequately counselled about
the safety and efficacy of therapeutic options. In addition,
proper patient selection is necessary to achieve good
results.
6. Overall conclusions
It is clear that the use of synthetic MUSs for surgical
treatment of SUI in both male and female patients has good
efficacy and acceptable morbidity. However, synthetic
mesh for POP should be used only in complex cases with
recurrent prolapse in the same compartment and restricted
to those surgeons with appropriate training who are
working in multidisciplinary referral centres. Patients
should be adequately informed regarding the potential
success rates and mesh-related adverse events compared
with nonmesh alternatives, and should be engaged in the
decision-making process.
We recommend the following as essential for the future:
1. Design implants specifically for their application, rather
than extrapolate from indications in abdominal wall
repair.
2. Establish accurate and complete databases registering
the numerator and denominator, patient profile and
surgical experience.
3. Establish long-term assessment in high-quality RCTs
and mandatory postmarketing registries.
4. Research new materials that should be introduced into
clinical practice according to a cautious and rigorous
process
5. Follow the evidence-based EAU and EUGA guidelines
.
6. Support and register the specialist training of surgeons
in urology and urogynaecology.
7. Encourage multidisciplinary team working.
8. Develop appropriate information for patients.
9. Collaborate with patient advocacy groups.
10. Encourage premarketing safety and efficacy data before
using a product in routine clinical practice.
11. Establish reference centres for reinterventions (com-
plicated cases).
12. Use condition-specific patient-reported outcome mea-
sures wherever possible.
Author contributions: Christopher Ronald Chapple had full access to all
the data in the study and takes responsibility for the integrity of the data
and the accuracy of the data analysis.
Study concept and design: None.
Acquisition of data: None.
Analysis and interpretation of data: None.
Drafting of the manuscript: Chapple, Cruz, Deffieux, Milani, Arlandis,
Artibani, Bauer, Burkhard, Cardozo, Castro-Diaz, Cornu, Deprest,
Gunnemann, Gyhagen, Heesakkers, Koelbl, MacNeil, Naumann, Roovers,
Salvatore, Sievert, Tarcan, Van der Aa, Montorsi, Wirth, Abdel-Fattah.
Critical revision of the manuscript for important intellectual content:
Chapple, Cruz, Deffieux, Milani, Arlandis, Artibani, Bauer, Burkhard,
Cardozo, Castro-Diaz, Cornu, Deprest, Gunnemann, Gyhagen, Heesak-
kers, Koelbl, MacNeil, Naumann, Roovers, Salvatore, Sievert, Tarcan, Van
der Aa, Montorsi, Wirth, Abdel-Fattah.
Statistical analysis: None.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: None.
Other: None.
Financial disclosures: Christopher Ronald Chapple certifies that all
conflicts of interest, including specific financial interests and relation-
ships and affiliations relevant to the subject matter or materials
discussed in the manuscript (eg, employment/affiliation, grants or
funding, consultancies, honoraria, stock ownership or options, expert
testimony, royalties, or patents filed, received, or pending), are the
following: Mohamed Abdel-Fattah: past speaker for Bard, Coloplast,
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