title: The bone anchor suburethral synthetic sling for iatrogenic male incontinence: critical evaluation at a mean 3-year followup.
abstract: OBJECTIVE
  We retrospectively report objective and subjective outcomes in 40 male patients who underwent bone anchored suburethral synthetic sling positioning for stress urinary incontinence due to intrinsic sphincter deficiency.
  
  
  METHODS
  Patients with stress urinary incontinence due to radical retropubic prostatectomy (32), robot assisted laparoscopic prostatectomy (3) and transurethral prostate resection (5) underwent bone anchored suburethral synthetic sling positioning between December 2002 and December 2007. Mean followup was 35.2 months (range 2 to 62). Previous anti-incontinence procedures, radiotherapy and transurethral procedures due to urethral stricture were performed in 5, 11 and 5 patients, respectively. Before and after surgery patients were evaluated by physical examination, urethral cystoscopy, urodynamics, a 1-hour pad test and a quality of life questionnaire. Patients were stratified into 3 groups, including group 1-cured (dry with a pad weight of 0 to 1 gm), group 2-improved (mild to moderate incontinence with a pad weight of 2 to 50 gm) and group 3-failed (patient condition unchanged with a pad weight of greater than 50 gm).
  
  
  RESULTS
  At the final followup visit 22 (55%), 5 (12.5%) and 13 patients (32.5%) were cured, improved and failed, respectively. Mean pad weight significantly decreased to 51.3 gm in 54% of cases, while the mean total questionnaire score significantly increased to 72.9 in 65% and abdominal leak point pressure significantly increased to 92.5 cm H(2)O in 52%. Statistical analysis showed a significant association between preoperative radiotherapy and treatment failure (85% of patients). Complications were perineal pain in 73% of cases, detrusor overactivity in 5% and sling infection in 15%.
  
  
  CONCLUSIONS
  The bone anchored suburethral synthetic sling is a simple and attractive procedure that can produce immediate good results with low morbidity, especially when strictly selected patients are treated. Radiotherapy remains a strong predictor of failure.
authors.affiliation: Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Giberti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gallo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Schenone
authors.forename: Pieluigi
authors.initials: P
authors.lastname: Cortese
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ninotta
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D011474:Prosthesis Design; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D053825:Suburethral Slings; D053441:Suture Anchors; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000601:surgery*; D014563:Urodynamics