Polypropylene mesh tape for male sphincteric incontinence

Abstract

Objective: Management of male sphincteric incontinence is still challenging. We present our experience with a new male sling technique using polypropylene mesh tape (PMT).

Material and methods: A total of 12 patients (age range 17-75 years; median age 61 years) underwent the procedure. Sphincteric incontinence was due to radical prostatectomy in three patients, transurethral prostatectomy in four, open prostatectomy in two and neurologic etiologies in three. All patients had urodynamic stress incontinence with a mean Valsalva leak point pressure of 48.8 cmH2O (range 40-68 cmH2O). Through a midline incision the PMT sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to a suprapubic incision with the help of trocars. The tension of the tape was adjusted during a retrograde sphincterometry until a retrograde leak point pressure of 30-50 cmH2O was achieved.

Results: The average operative time was 65 min (45-110 min). Follow-up was 12.1-46.4 months (median 31.6 months). Urinary incontinence was cured or improved in nine patients (75%) and there was no improvement in three (25%). Intermittent catheterization was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intraoperative bladder perforation and one had perineal numbness lasting for 2 months. None of the patients had urethral erosion, wound infection or any other major complications.

Conclusions: This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Regarding the etiology of urinary incontinence, this technique seems to be more effective in transurethral prostatectomy-related sphincteric incontinence than in sphincteric incontinence of other etiologies. Further experience with more patients and a longer follow-up period is mandatory to determine the long-term effectiveness of the technique.