The male perineal sling for the treatment of neurogenic urinary incontinence

Abstract

Purpose The treatment of the incompetent bladder neck in boys with neurogenic bladders is difficult. We have adapted the AMS Invance sling to treat this group of patients. This device was originally developed to treat urinary incontinence post-radical prostatectomy. Material and methods The InVance male sling system (AMS) was used in 4 boys with a history of spina bifida and urinary incontinence. The boys ranged in age from 15 years to 19 years. Follow-up ranges to 18 months. Urodynamics confirmed low leak point pressures and adequate vesical compliance and capacity. The procedure was performed on an out-patient basis. A silicone coated polyester sling was placed through a perineal incision. Three titanium screws were used in conjunction with polypropylene sutures to secure the sling on either descending pubic rami. Results A total of five slings were placed in 4 patients. One sling required replacement secondary to inadequate fixation. One sling was removed after a local wound infection developed. Of the 3 patients with the sling in place, all are completely continent. They are able to perform intermittent catheterization without difficulty. Conclusions This out-patient technique offers the potential of achieving long-term urinary continence in boys using a perineal based sling. Further studies of this approach are warranted based on these preliminary results. The treatment of the incompetent bladder neck in boys with neurogenic bladders is difficult. We have adapted the AMS Invance sling to treat this group of patients. This device was originally developed to treat urinary incontinence post-radical prostatectomy. The InVance male sling system (AMS) was used in 4 boys with a history of spina bifida and urinary incontinence. The boys ranged in age from 15 years to 19 years. Follow-up ranges to 18 months. Urodynamics confirmed low leak point pressures and adequate vesical compliance and capacity. The procedure was performed on an out-patient basis. A silicone coated polyester sling was placed through a perineal incision. Three titanium screws were used in conjunction with polypropylene sutures to secure the sling on either descending pubic rami. A total of five slings were placed in 4 patients. One sling required replacement secondary to inadequate fixation. One sling was removed after a local wound infection developed. Of the 3 patients with the sling in place, all are completely continent. They are able to perform intermittent catheterization without difficulty. This out-patient technique offers the potential of achieving long-term urinary continence in boys using a perineal based sling. Further studies of this approach are warranted based on these preliminary results.