title: Efficacy of the bulbourethral autologous sling in treating male stress urinary incontinence: a three-year experience from a single center.
abstract: OBJECTIVE
  To evaluate the efficacy of the bulbourethral rectus autologous sling in treating male stress urinary incontinence.
  
  
  METHODS
  We retrospectively reviewed operative logs from a single surgeon of 32 male patients treated over a 3-year period (March 2001 to March 2004) for stress incontinence by implantation of a bulbourethral free rectus sling. The mean age of the patients was 46.4 (range 14-76); mean follow-up time was 29.5 months (range 24-52). Neurogenic dysfunction was the most common cause of incontinence in this group (17/32 cases; 53.1%). Efficacy was evaluated objectively in terms of the number of pads used per day, subjective patient satisfaction, and morbidity. We also investigated a possible correlation between pre-operative parameters and outcome.
  
  
  RESULTS
  Ten patients (31.3%) were cured (totally dry, 15.6%; the remainder one pad per day), while five (15.6%) patients improved but still required two pads per day. Overall, 15 of 32 patients (46.9%) were satisfied with the outcome of the operation. In total, seven patients presented a mild complication (21.9%). De novo urgency was the most common complication presented in four of 32(11.6%). No case of urethral erosion was encountered. Univariate analysis failed to find any correlation between the final outcome and the following parameters: patient age, duration of incontinence, earlier anti-incontinence surgery, severity of pre-operative incontinence, pre-operative Valsalva leak point pressure, decreased compliance, decreased bladder capacity, and pre-operative evidence of detrusor overactivity.
  
  
  CONCLUSIONS
  In conclusion, the free rectus fascia bulbourethral sling is a modestly effective technique for the treatment of male stress incontinence with mild morbidity. The use of this method seems that it is suitable for selected cases.
authors.affiliation: Department of Urology, Medical School, University of Michigan, Ann Arbor, USA. tassos_athan@hotmail.com
authors.forename: Anastasios
authors.initials: A
authors.lastname: Athanasopoulos
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McGuire
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005205:Fascia / Q000637:transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D013997:Time Factors; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
references.citation: J Urol. 1998 May;159(5):1510-5
references.pmid: 9554344
references.citation: Urology. 2008 Jun;71(6):1191-5
references.pmid: 18538695
references.citation: Urology. 2009 Jun;73(6):1363-7
references.pmid: 19376562
references.citation: Urology. 1993 Apr;41(4):318-21
references.pmid: 8470315
references.citation: J Urol. 2006 Nov;176(5):2114-8; discussion 2118
references.pmid: 17070273
references.citation: J Urol. 1992 Apr;147(4):1073-5
references.pmid: 1552586
references.citation: Urology. 1998 May;51(5):715-20
references.pmid: 9610584
references.citation: J Urol. 1998 Aug;160(2):364-7
references.pmid: 9679878
references.citation: J Urol. 2001 Oct;166(4):1372-5
references.pmid: 11547077
references.citation: J Urol. 2003 Jan;169(1):199-202
references.pmid: 12478135
references.citation: J Urol. 2008 May;179(5):1912-6
references.pmid: 18353376
references.citation: Scand J Urol Nephrol. 1975;9(1):24-7
references.pmid: 1215841
references.citation: J Urol. 2005 May;173(5):1657-60
references.pmid: 15821530
references.citation: J Urol. 2001 Jun;165(6 Pt 2):2369-71; discussion 2371-2
references.pmid: 11398778
references.citation: J Urol. 2007 Apr;177(4):1414-8
references.pmid: 17382743
references.citation: J Urol. 2002 Feb;167(2 Pt 1):597-601
references.pmid: 11792925
references.citation: J Urol. 1988 Mar;139(3):528-31
references.pmid: 3343738
references.citation: J Urol. 1997 Mar;157(3):926-8
references.pmid: 9072601
references.citation: BJU Int. 2009 Feb;103(4):500-4
references.pmid: 18782301
references.citation: Urol Nurs. 1996 Jun;16(2):50-4
references.pmid: 8826153
references.citation: Eur Urol. 2009 Dec;56(6):923-7
references.pmid: 19748174
references.citation: J Urol. 2005 May;173(5):1654-6
references.pmid: 15821529
references.citation: BJU Int. 2002 Oct;90(6):550-3
references.pmid: 12230615
references.citation: J Urol. 2001 Nov;166(5):1755-8
references.pmid: 11586217
references.citation: Eur Urol. 2007 Jun;51(6):1709-14; discussion 1715-6
references.pmid: 17011113
references.citation: Rev Urol. 2004 Fall;6(4):180-6
references.pmid: 16985599
references.citation: Br J Urol. 1973 Dec;45(6):646-53
references.pmid: 4775740