Parietex™ Mini Male Sling for Stress Urinary Incontinence at the Time of Three Piece Penile Prosthesis: Technique and Outcomes

Abstract

Abstract Male stress urinary incontinence (SUI) is often comorbid with erectile dysfunction (ED) post prostatectomy. While the three piece inflatable penile prosthesis (IPP) is the gold standard surgical option for ED, there are many surgical options for male SUI as well as climacturia. We present our technique and outcomes for mini male sling (MMS) with IPP insertion for mild SUI and climacturia using a monofilament polyester mesh. A retrospective review of all IPPs performed by a single high-volume prosthetic urologist was conducted. A subset of men who underwent IPP insertion with concomitant MMS were identified and analyzed. The technique of MMS placement involves measurement of an approximately 5x3 cm two layered Parietex™ mesh (Covidien, MN); the mesh is overlayed ventrally on the bulbar urethra at the penoscrotal junction, just proximal to the corporotomy sites. The Parietex™ mesh includes a hydrophilic absorbable collagen film to minimize tissue reaction and risk of erosion. The lateral edges of the mesh are sutured to the 3 and 9 o’clock positions on the left and right corporal bodies, respectively, using a nonabsorbable, braided suture. Tightness of mesh is measured using the proximal end of a Debakey forceps, with ease of passage when the IPP is deflated, and inability to pass forceps when the IPP is inflated. A total of 63 men underwent IPP with MMS between January 2018 and October 2022. All patients had a diagnosis of concomitant ED and SUI after radical prostatectomy. Average IPP size was 21 cm with a 1 cm rear tip extender. A total of 59 men had SUI, with an average pad per day (PPD) of 1.5. Twenty-five men with SUI had comorbid climacturia, and 4 men had preoperative climacturia without SUI. Average PPD post IPP with MMS was 0.1. Of the 29 men with preoperative climacturia, only one did not have resolution of his symptoms post MMS. There was only one reported complication of acute urinary retention requiring sling removal. Two patients required subsequent AUS insertion, and two required IPP revision for malpositioned cylinders. There were no reported cases of infection or mesh erosion. The Parietex™ mesh is a safe, cost-effective, easy to use, and an effective material for mini male sling insertion at the time of IPP placement for men with ED and mild SUI or climacturia.