Efficacy of the bulbourethral autologous sling in treating male stress urinary incontinence: a three-year experience from a single center.
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.
Athanasopoulos
Anastasios
A
Department of Urology, Medical School, University of Michigan, Ann Arbor, USA. tassos_athan@hotmail.com
McGuire
Edward J
EJ
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
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