Historical milestones in male continence surgery: From early urethral supports to modern sling systems

Male stress urinary incontinence (SUI) represents a substantial postoperative and functional burden among men, particularly following radical prostatectomy. Over the past century, therapeutic concepts have progressed from autologous fascial grafts to anatomically tailored synthetic sling systems. This narrative historical review outlines the evolution of male urethral sling technologies, describing the key design principles, materials, and surgical instruments that shaped their development. Using structured searches of Ovid, PubMed, and Google Scholar, together with grey literature sources, we identified historical milestones that defined three major eras of innovation. Era I (1900–1972) established foundational concepts, beginning with early fascial slings and progressing to the Berry and Kaufman procedures, which introduced synthetic materials and initial attempts at male-specific urethral support. Era II (1972–1998) marked a developmental gap driven largely by the introduction of the artificial urinary sphincter and the absence of standardized sling techniques. The widespread adoption of radical prostatectomy in the late 1980s renewed interest in alternative continence solutions. Era III (1998–present) represents the maturation of modern sling systems, encompassing bone-anchored slings, retropubic and transobturator repositioning slings, and adjustable compression devices such as InVance™, Argus™, Remeex™, ATOMS™, and AdVance™. Improvements in materials, fixation mechanisms, tension-adjustment features, and transobturator instrumentation have significantly enhanced safety and efficacy. Understanding the historical trajectory of male sling devices highlights how iterative refinement in biomechanics, biomaterials, and surgical tools has shaped contemporary continence surgery. Continued innovation—guided by long-term outcomes, device durability, and individualized patient selection—remains essential for optimizing future sling design and expanding therapeutic indications.