USE OF THE FASCIAL SLING FOR NEUROGENIC INCONTINENCE - LESSONS LEARNED

Experience using the fascial sling to manage incontinence in 10 patien ts with a neurogenic bladder is described. The sling was constructed f rom rectus abdominus fascia in the first 5 cases. Because of 2 sequent ial failures attributed to inadequacy of the fascial material fascia l ata was used in the last 5 cases. Six patients underwent bladder augme ntation concomitant with sling construction. Of the 10 patients 9 were perfectly dry immediately after surgery, although with longer followu p several patients became wet. The source of the fascial material used to make the sling did not affect the long-term outcome. Of the 6 pati ents who underwent augmentation at the time of sling construction 4 re main dry at long-term followup. On the other hand, only 1 of the 4 pat ients who did not undergo augmentation when the sling was positioned h ad a good long-term result. Erosion of the fascial sling was suspected in 3 patients who had difficulty with catheterization after surgery. Three patients required bladder augmentation because of changes in det rusor behavior subsequent to sling construction. This series suggests that combining the fascial sling with bladder augmentation appreciably increases the likelihood of achieving dryness and that excessive comp ression of the urethra by the fascial sling may lead to erosion. The s ling, as an isolated procedure for neurogenic incontinence, should onl y be used in exceptionally capacious compliant bladders.