Le site de vulgarisation scientifique de l’Université de Liège. ULg, Université de Liège

Male urinary incontinence: a new surgical treatment
6/26/14

And for males?

Jean de Leval asked himself the question: Why not insert this type of mesh implant in males too?  In 2006, he presented a new system which made it possible to carry out the procedure on patients suffering from stress urinary incontinence after radical prostatectomy.

In males, stress urinary incontinence is quite frequent, especially in the case of prostate disease. On the other hand, males are less subject to stress incontinence than females: in males, stress incontinence occurs almost always only after prostate surgeries and in particular, for prostate cancer (radical prostatectomy). "Because there are a large number of operations I thought about trying to do something for these patients", he continues.

Today the preferred method of treating stress urinary incontinence after total removal of the prostate gland is the artificial urinary sphincter. The American Brantley Scott developed the best artificial sphincter system in the seventies and it is still used today.

artificial sphincter
"It involves the insertion of a small cuff around the urethra, which is connected to a small liquid-filled balloon and a small pump used to activate the system. This pump is located in the scrotum in males and in one of the labia in females, you press on it to open and close and to fill and empty the cuff".

Using a mesh implant to treat male incontinence was therefore considered, and currently there is a large variety of them. Unlike the procedure for females, one needs to apply a significant pressure to the mesh implant in order to have sufficient tension.


After several years of research, the team of Professors Jean de Leval and David Waltregny (head of the Urology Department of the University Hospital of Liege), developed a new system of bulbar urethra compression. The mesh implant and instruments were first manufactured by the University Hospital of Liege in the Department of Biomechanics. Late April 2014, the TOM-Sling (Trans Obturator Male-Sling), obtained the EC conformity marking, which is mandatory for launching a product on the market. It is manufactured and marketed by Medi-Line.

A simple and effective kit

The TOM-Sling is a urethral compression mesh device. The kit is composed of an insertable polypropylene mesh implant (a material which is well-tolerated by the body), two arms designed to ensure optimal positioning of the mesh, these two lateral arms are inserted via a transobturator route inside (under the urethra) -out (thigh root) through the obturator foramens, a pair of patented passers, a winged guide, a pair of flexible tubes, and a pair of pull-wires.

The surgical procedure and instruments that have been patented by the University Hospital of Liege through the University-Enterprises Interface make it possible to find the precise positioning and optimal tension for the mesh implant, which are essential factors for restoring continence. Only experienced urologist surgeons involved in the management of these specific urinary disorders and who have had a specific training in the TOM-Sling technique by their peers can obtain the kit.
The operation takes 45 to 60 minutes, under local or general anesthesia.

In case of total prostatectomy

The procedure is indicated for men suffering from disabling moderate to severe incontinence 12 months after total prostatectomy and for whom conservative measures have failed. It should be noted that around 10% of these patients will experience persistent stress urinary incontinence after one year. Among this group, around 30% will have severe incontinence and 70% will experience mild to moderate incontinence. The urologist explains, “During the first few months, we carry out physiotherapy, perineal reeducation, electro stimulation etc., and the patients are eventually proposed a surgical intervention. This is for those who have had their prostate removed completely: we remove the gland and the urinary channel that is located there". Several sphincters are involved in controlling urination: the bladder neck, the urethra and the striated sphincter. In case of radical prostatectomy, a portion of the sphincter mechanisms is removed.

Page : previous 1 2 3 4 next

 


© 2007 ULi�ge