Bone anchored sling for the treatment of post-prostatectomy incontinence

Purpose: This ongoing study evaluates the safety and efficacy of a new mini mally invasive sling procedure for treating post-prostatectomy incontinence . Materials and Methods: A total of 16 men 56 to 74 years old (mean age 67) u nderwent the procedure using the Straight-Int bone anchoring system. Time a fter prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed in continence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal a pproach. Four miniature bone screws with pre-attached pairs of No. 1 polypr opylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the sym physis on each side, and the second pair is inserted 3 to 4 cm. lower. To s upport the bulbar urethra a gelatin coated polyethylene terephthalate trape zoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure. Results: Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodyn amic diagnosis of genuine stress incontinence 12 were cured of incontinence , defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preopera tive diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence b ut persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications wer e minimal with no erosion, infection or osseous complications. Conclusions: This new minimally invasive male sling procedure is safe and e fficacious. Adjusting sling tension by measuring urethral resistance result s in a low rate of over correction and failure. Further experience is neede d to establish this procedure as treatment for postprostatectomy incontinen ce.