Modified bulbar urethral sling procedure for the treatment of male sphincteric incontinence

Urinary incontinence secondary to intrinsic sphincter deficiency is a debilitating condition for the patient and an ordeal for the urologist. Because of the complexity of reconstructive surgical techniques and the prohibitive cost of the prosthetic devices used, there is a need for a simple procedure. We herein report our experience in managing urinary incontinence secondary to sphincteric incompetence in nine consecutive patients using a modified bulbar urethral sling procedure over a period of 2 years.

In eight patients, the incontinence followed open prostatectomy or transurethral resection for benign prostatic hyperplasia, and one patient had incontinence following fulguration of posterior urethral valves. Our procedure uses bolsters that are suspended from the rectus fascia, and a hammock made of a folded Dacron patch is placed beneath the bulbospongiosus muscle to form a sling.

All patients were continent postoperatively, with only mild stress leakage in the erect posture, during a mean follow-up of 12.2 months (range 6-22 months) and required one or two improvised pads per day to remain continent during the daytime. Persistent perineal infection necessitated removal of the sling in one patient. One patient required clean intermittent catheterization for a short period postoperatively.

This modified bulbar urethral sling procedure is a simple yet effective method to treat sphincteric deficiency of any cause.