Sling may hasten return of continence after radical prostatectomy.
OBJECTIVE
To place absorbable slings in 15 men at radical retropubic prostatectomy in an attempt to hasten recovery of continence.


METHODS
Fifteen men underwent placement of a sling immediately after prostatectomy by a single surgeon. A strip of either porcine small intestine submucosa (SIS) or polyglactin mesh was placed beneath the anastomosis. The initial five slings were tension free. The last 10 were tightened just to the point they began to elevate the anastomosis. A comparison was made with the same number of men who underwent radical retropubic prostatectomy immediately before beginning this project. The average follow-up was 28.9 months.


RESULTS
The first 5 sling patients (no tension) recovered complete bladder control in an average of 5.8 weeks. The 10 men with slings placed under slight tension were dry an average of 2.6 weeks after catheter removal, including 4 within 24 hours. One month later, 10 sling patients (67%) were continent, including 8 (80%) who had had the sling placed under slight tension. Six (40%) of 15 control patients were completely dry in that interval. Three months later, all but 1 sling patient (93%) was dry, but only 7 (47%) of 15 controls. All, except 1 control, were dry at 12 and 24 months. No complications were attributed to this maneuver, specifically no bladder neck contracture or retention occurred. No one in either group received incontinence treatment, although 2 control patients had either stricture or bladder neck contracture.


CONCLUSIONS
The early results have been encouraging, but must be confirmed. Slight tension on the sling may be beneficial.
Jones
J Stephen
JS
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. joness7@ccf.org
Vasavada
Sandip P
SP
Abdelmalak
Joseph B
JB
Liou
Louis
L
Ahmed
Elazab S
ES
Zippe
Craig D
CD
Rackley
Raymond R
RR
D020341:Absorbable Implants; D000368:Aged; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation; D007421:Intestine, Small / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D013526:Surgical Mesh; D013536:Suture Techniques; D014549:Urinary Incontinence / Q000517:prevention & control*; D014554:Urination; D013519:Urogenital Surgical Procedures
D011098:Polyglactin 910