Editing Functional: Surgery for Male SUI (section)

===== Bulbar Urethral Sling =====
*<span style="color:#ff0000">'''Indication'''</span>
**'''<span style="color:#ff0000">Consider for mild to moderate SUI</span>'''
*** '''Mild-to-moderate incontinence defined as a 24-hour pad weight < 150 g for mild UI and < 400 g for moderate UI'''
***'''<span style="color:#ff0000">Poor efficacy in comparison to an AUS in patients with severe incontinence.</span>'''
**Alternatives for those who refuse AUS from fear of infection, erosion, or mechanical failure, as well as those with limited physical or cognitive capacity
*'''<span style="color:#ff0000">Contraindications (3):</span>'''
*# '''<span style="color:#ff0000">Radiation</span>'''
*# '''<span style="color:#ff0000">Urethral erosion</span>'''
*# '''<span style="color:#ff0000">Severe gravitational urinary incontinence</span>'''
* '''Types (3)'''
*# '''InVance''' (AMS): '''mesh placed outside the bulbospongiosus muscle and anchored to the pubic rami'''
*#* '''No longer available in the US'''
*#* '''Mechanism of continence thought to be from compression of urethra'''
*# '''AdVance''' (AMS): '''transobturator fixation of mesh'''
*#* '''Mechanism of continence thought to be from enhanced rhabdosphincter function without significant compression; designed to reposition and lengthen the membranous urethra'''
*#* See [https://www.medgadget.com/2019/02/advance-xp-male-sling-system-for-urinary-incontinence-now-available-in-u-s.html Figure]
*# '''Virtue''' (Coloplast): '''combined prepubic and transobturator sling'''
*#* Four-armed mesh device (quadratic fixation) that provides a '''long segment of urethral compression''' against the urogenital diaphragm '''and a separate elevation component''' because of the prepubic and transobturator arms, respectively
*#* '''Limited data on efficacy and durability'''
* '''After urethral disruption due to pelvic fracture, neither the InVance or the AdVance slings are likely to reliably provide effective elevation, elongation, or compression because of distortion of the bony pelvic anatomy''' and high likelihood of rhabdosphincter damage
* '''Technique'''
**'''Determining the appropriate tension of the sling is the most critical portion of the operation'''
* '''Adverse events''' (generally low complication rate):
**'''Urinary retention'''
***Typically resolves within 1 week
**'''Pelvic and perineal pain and paresthesia'''
***Typically resolves within 12 weeks
**'''Anchoring complications from bone anchors'''
**'''Erosion or infection'''
***'''Both are exceedingly rare.'''
****If a male sling is thought to be infected or documented to be eroded on cystoscopy, the '''management is similar to management of an infected or eroded AUS (see below)'''