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Published on: June 16, 2022
Outpatient perineal sling in adolescent boys with neurogenic incontinence
Gregory E Dean1, David A Kunkle
1Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. gregoryedean@gmail.com
Insights
A male perineal sling offers a durable outpatient solution for neurogenic incontinence in adolescent boys with sphincteric incompetence. This minimally invasive approach shows promising results for achieving continence and patient satisfaction.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Neurogenic Bladder Management
Background:
- Urinary incontinence in boys with neurogenic sphincteric incompetence presents management challenges.
- Current treatments like minimally invasive procedures and open surgery have limitations, including inconsistent efficacy, need for multiple treatments, inpatient stays, and high complication rates.
Purpose of the Study:
- To evaluate the efficacy and durability of a polypropylene male perineal sling as an outpatient procedure for neurogenic incontinence in male adolescents.
Main Methods:
- A retrospective review of 6 male adolescents (14-20 years old) with myelomeningocele and neurogenic sphincteric incontinence who underwent outpatient placement of a polypropylene male perineal sling.
- Sling placement involved a small perineal incision with tension adjusted for urethral compression and catheter passage.
- Follow-up ranged from 27 to 39 months (median 33 months).
Main Results:
- All 6 patients achieved immediate complete continence post-sling placement.
- Two slings were removed due to local infection, with one requiring replacement.
- One sling needed revision for anchor fixation issues; no urethral erosions occurred.
- Five patients with the sling in place maintained continence with intermittent catheterization and reported high satisfaction.
Conclusions:
- The male urethral sling appears to be a viable outpatient option for managing neurogenic incontinence due to sphincteric incompetence in adolescent males.
- The procedure demonstrated encouraging durability in the initial patient cohort.
- Further research is needed to optimize strategies for reducing complication rates.
Purpose:
Management for urinary incontinence in boys with sphincteric incompetence secondary to a neurogenic etiology is a challenge. Minimally invasive approaches have inconsistent efficacy and may require multiple treatments. Open bladder neck reconstruction requires inpatient hospitalizations and can be associated with a high complication rate. To overcome some of these shortcomings we placed a polypropylene male perineal sling in male adolescents with neurogenic sphincteric incontinence. We retrospectively reviewed the outcome in our initial 6 patients.
Materials And Methods:
Six patients 14 to 20 years old underwent placement of a polypropylene male perineal sling on an outpatient basis. Followup was 27 to 39 months (median 33). All patients had a history of myelomeningocele and underwent urodynamics showing normal compliance, adequate capacity and sphincteric incompetence. A suburethral sling was placed on an outpatient basis through a small perineal incision. Sling tension was adjusted for maximal urethral compression while still permitting uncomplicated urethral catheter passage.
Results:
All 6 patients reported immediate complete continence after sling placement. Two slings were removed after local infection developed and 1 was replaced. Another sling required revision secondary to incomplete bone anchor fixation. No patients had urethral erosion. All 5 patients with a sling currently in place were fully continent on intermittent catheterization every 3 hours and they reported excellent satisfaction with the procedure.
Conclusions:
Our retrospective study suggests that the male urethral sling may be an outpatient option for neurogenic incontinence secondary to sphincteric incompetence. Long-term followup in our initial 6 patients shows encouraging durability. Continued study is required to determine strategies that might decrease the complication rate of this approach.
