Perineal sling for the treatment of severe male incontinence, a cohort study

Purpose Post radical cystectomy/post-traumatic incontinence is challenging. Albeit not life-threatening; it has significantly negative impact on patients’ quality of life. We studied the application of customized perineal sling in treatment of these two conditions. Methods Men after RCOD with significant daytime incontinence had MRI, basic laboratory testing and 1-hour pad test. Patients with post traumatic incontinence had anastomotic urethroplasty at least once. All had a median 5 pad/day. Tailored to the size of the patient’s bulb, Polypropylene mesh is fixed by 4 No 1. Ethilon sutures, to the inferior pubic ramus. Results Group 1 included 12 patients; mean age: 67 years. (56–80 years). No evidence of local recurrence prior to sling. Mean BMI: 25.62 (range: 22-32.4) Mean pad weight was 112.5 gm. (80–200). 12 months after surgery, pad test was negative in 6 patients (50%) and positive in 6, with mean increase of 17.8 gm. (range 1–80 gm.). Average pad use was 2 pads /day (1–3). Mean PVR was 15.3 ml (range: 1–82). Group 2: 4 patients. Mean age: 29.3 years. All had anastmotic urethroplasty for post- traumatic stricture. Median incontinence duration was 24 months (24–120). Median follow up was 50 months (32–70). At the time of last follow up, 3 out of 4 (75%) were either completely dry or showed significant improvement with only one pad /day. Conclusion At 1 year this customized perineal sling is a safe, easy to learn and effective mode of treatment of severe male incontinence.