Urinary continence and erectile function after bladder neck sling suspension in male patients with spinal dysraphism

Objective To assess the outcome of using sling suspensions combined with cl ean intermittent catheterization (CIC) in patients with spina bifida, of wh om a third are incontinent through pelvic floor paralysis. Patients and methods Between March 1992 and April 1997, 14 male patients (m ean age at surgery 11.7 years, range 6.5-15.2) with spina bifida and neurog enic sphincter incontinence underwent puboprostatic sling suspension as a p rimary treatment. The procedure, via an abdominoperineal approach, consists of suspending the bladder neck by placing a simple U-shaped rectus abdomin us fascial sling. The perineal approach is used to develop the plane betwee n the rectum and Denonvillier's fascia, and to prepare the passage of the s ling alongside the prostate. Apart from the sling procedure, eight of the 1 4 patients underwent autoaugmentation of the bladder and two underwent ileo cystoplasty during the same operation. All patients used CIC daily, Erectil e function was assessed by reports from the patients and their parents, and continence by report and urodynamic studies. Results Of the 14 patients, 13 achieved urinary continence with no addition al procedures; one required a subsequent submucosal injection at the suspen sion site with silicons particles in povidone (Macroplastique(R)) to become continent. Two patients reported slight leakage at night. Before surgery, all but one patient reported having spontaneous or mechanically manipulated erections; none had erections on psychological stimulation. After surgery, erectile function was preserved in 13 of the 14 patients; in one there wer e problems establishing the right dissection plane between the rectum and p rostate, but spontaneous erections returned a year after surgery. Conclusion In males, the abdominoperineal puboprostatic sling suspension us ing rectus abdominis fascia appears to be a successful treatment for sphinc ter incontinence in patients with spina bifida, and safely maintains erecti le function.