Longitudinal urethral sling with prepubic and retropubic fixation for male urinary incontinence

Abstract

Objective: Description and early results of a new urethral sling technique for treatment of postprostatectomy urinary incontinence, which combines efficacy, low cost and technical simplicity. Materials and Methods: From May 2003 to April 2004, 30 patients with moderate or total urinary incontinence, following radical prostatectomy or endoscopic resection of the prostate, underwent the new technique. The technique is based on the placement of a longitudinal-shaped sling in the bulbar urethra, measuring 4 cm in length by 1.8 cm in width, made of Dacron or polypropylene mesh, fixed by 4 sutures on each side, with 2 sutures passed with Stamey-Pereira needle by retropubic approach and 2 by prepubic approach, which are then tied over the pubis.Pressure control was determined by interrupting the loss of infused water through a suprapubic cystostomy 60 cm from the pubis level.Results: Pre-operative assessment excluded vesical instability, urethral stenosis and urinary infection. Suprapubic cystostomy was removed when the patient was able to satisfactorily void with urinary residue lower than 100 mL, which occurred in 29 of the 30 cases. In 2 cases, there was infection of the prosthesis, requiring its removal. In 3 cases, there was the need to adjust the sling (increasing the tension), due to failure of the urinary continence. Overall, 20 of 30 (66.7%) operated patients became totally continent, and did not require any kind of pads. Four of 30 (13.3%) patients achieved partial improvement, requiring 1 to 2 pads daily and 6 of 30 (20%) patients had minimal or no improvement. There was no case of urethral erosion.Conclusion: This new sling technique has shown highly encouraging preliminary results. Its major advantage over other surgical techniques for treatment of moderate or severe stress urinary incontinence is the simplicity for its execution and low cost. A long-term assessment, addressing maintenance of continence, detrusor function and preservation of the upper urinary tract, is still needed.

The male sling for post‐prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes

“…Schaal et al . [81] reported a modification of the retropubic sling that involved passing the anchoring sutures prepubically and retropubically, and then tying them over the pubic symphysis. Several other authors have reported on their experiences with home‐made retropubic slings [82–84].…”

Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review

“…The cure rate in the included studies ranged from 63% to 98% and the quality of life improved post sling surgery for all 4 studies. Retrourethral transobturator slings, such as the AdVance and I Stop TOM slings, have been extensively studied, and in fact, the majority of sling studies in our meta-analysis (n = 16) [12–14,16–21,26,27,29,31–33] investigated the efficacy of this type of sling. The cure rate for the included studies ranged from 9% to 85% and similar to the bone-anchored sling, use of the retrourethral transobturator slings improved the quality of life in all studies.…”

The ‘ventral urethral elevation plus’ sling: a novel approach to treating stress urinary incontinence in men

“…[17] described a polypropylene mesh tape that is passed through the perineal membrane on each side, with the limbs of the tape passed suprapubically. Several groups have reported small series of patients who had a bulbar urethral sling placed and supported by four suprapubic sutures, similar to the four‐corner anterior vaginal wall suspension in females [18–20]. Unfortunately, these studies are limited as they had few patients, a short follow‐up, no standardized or validated outcome measures, and a general lack of urodynamic data.…”