Polypropilene sling of the bulbar urethra for post-radical prostatectomy incontinence

We present details of a modification of the Stamey procedure using a polypropilene mesh to compress the corpus spongiosum of the bulbar urethra in the treatment of sphincteric incompetence following radical prostatectomy.

Between September 1999 and June 2000 nine patients 66-80 years old (mean age 74) with severe incontinence due to radical prostatectomy underwent the bulbourethral sling procedure with polypropilene (Prolene) mesh implant. After transperineal incision a 5cmx4cm rectangular prolene mesh was placed against the bulbar urethra and suspended by four prolene sutures transferred to a suprapubic incision through ligature carriers as in the four corner bladder and bladder neck suspension. If leakage recurred in the follow-up, a retightening procedure was performed in local anesthesia rescuing the prolene threads over a polypropilene mesh placed against the rectus fascia. Mean follow-up was 14 months (range 12-20). Continence status and post-void residual volume were evaluated after 1, 3 and 6 months post-operatively and successively every 3 months.

At the present follow-up considering the results of the retightening procedure five out of nine patients were cured, two out of nine improved and two were unchanged. Five out of nine patients reported slight to mild perineal/genital discomfort which disappeared in four at three months post-operatively. No patients required mesh removal for complications.

The male bulbourethral sling procedure using a polypropilene mesh is safe but further experience is needed to establish this procedure as plausible alternative for the treatment of post-radical prostatectomy urinary incontinence.