What is the evidence base for this information?
This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrooke’s. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.
What does the procedure involve?
The male sling is a treatment for male stress urinary incontinence. It involves placement of a synthetic sling that supports the waterpipe (urethra). The procedure will involve a cystoscopic examination of the urethra and bladder and an incision in the area behind the scrotum (perineum), with two further small cuts in the groin crease.
What are the alternatives to this procedure
Incontinence into a pad, a urethral catheter or an artificial urinary sphincter.
What should I expect before the procedure
You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post operatively.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel, ticagrelor or blood thinning medication
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical
- dural transplant or previous injections of human derived growth hormone)
What happens during the procedure?
You will have a small incision in the area between the scrotum and anus (the perineum) and two further small cuts in the groin crease. The sling will sit in this area. You will also have a urinary catheter placed.
What happens immediately after the procedure?
You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise as soon as you are comfortable to prevent blood clots forming in your legs. You will be given intravenous antibiotics through your vein. You will normally be discharged the day after your operation, usually after your catheter has been removed.
Are there any side effects?
Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:
Common (greater than one in 10)
- Stinging when you urinate.
- Urinary retention.
- Temporary perineal pain.
- Treatment failure.
- Benefits of treatment may reduce over time.
Occasional (between one in 10 and one in 50)
- Wound infection.
- Overactive bladder symptoms (frequency and urgency of urination).
Rare (less than one in 50)
- Urethral erosion.
- Bone or soft tissue infection.
What should I expect when I get home?
It is important to undertake light duties for six weeks following surgery. This will help prevent any sling slippage which may affect the efficacy of the sling.
What else should I look out for?
Men who undergo surgery in the perineum (between the anus and the scrotum) may find it easier to sit with your weight shifted onto your one of your buttocks. You may find it more comfortable to sit using an air filled donut, soft cushion or another type of pillow, especially for the first four weeks after surgery. Any activity that requires you to straddle anything, such as riding a bicycle, motorcycle or a horse should be avoided for four to six weeks.
Are there any other important points?
You will be reviewed in outpatients to see how you have got on. It is likely you will be asked to complete a questionnaire on your symptoms.
Driving after surgery
It is your responsibility to ensure that you are fit to drive following your surgery.
You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.
Privacy and dignity
Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.
Hair removal before an operation
For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery. Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.
Is there any research being carried out in this field at CUH?
All operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting. During 2014 and 2015 Addenbrooke’s Hospital was recruiting men to the MASTER trial. This a national trial funded by the NIHR.
Who can I contact for more help or information?
Uro-oncology nurse specialist
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
Prostate cancer nurse practitioner
01223 274608 or 216897 or bleep 154-548
Surgical care practitioner
01223 348590 or 256157 or bleep 154-351
Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608 or 586748 or bleep 157-237
Urology nurse practitioner (stoma care)
Urology nurse practitioner (stone disease)
01223 349800 or bleep 152-879
Patient advice and liaison service (PALS)
Telephone: +44 (0)1223 216756
PatientLine: *801 (from patient bedside telephones only)
Mail: PALS, Box 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
Chaplaincy and multi faith community
Telephone: +44 (0)1223 217769
Mail: The Chaplaincy, Box 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
MINICOM System (‘type’ system for the hard of hearing)
Telephone: +44 (0)1223 217589
Access office (travel, parking and security information)
Telephone: +44 (0)1223 596060
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
Telephone +44 (0)1223 245151