Use of the fascial sling for neurogenic incontinence: lessons learned

Experience using the fascial sling to manage incontinence in 10 patients with a neurogenic bladder is described. The sling was constructed from rectus abdominus fascia in the first 5 cases. Because of 2 sequential failures attributed to inadequacy of the fascial material fascia lata was used in the last 5 cases. Six patients underwent bladder augmentation concomitant with sling construction. Of the 10 patients 9 were perfectly dry immediately after surgery, although with longer followup several patients became wet. The source of the fascial material used to make the sling did not affect the long-term outcome. Of the 6 patients who underwent augmentation at the time of sling construction 4 remain dry at long-term followup. On the other hand, only 1 of the 4 patients who did not undergo augmentation when the sling was positioned had a good long-term result. Erosion of the fascial sling was suspected in 3 patients who had difficulty with catheterization after surgery. Three patients required bladder augmentation because of changes in detrusor behavior subsequent to sling construction. This series suggests that combining the fascial sling with bladder augmentation appreciably increases the likelihood of achieving dryness and that excessive compression of the urethra by the fascial sling may lead to erosion. The sling, as an isolated procedure for neurogenic incontinence, should only be used in exceptionally capacious compliant bladders.