Urethral needle suspension for male urinary incontinence

A rectus fascia sling was used to suspend the bulbous urethra in 12 males with total sphincteric incontinence. Incontinence was related to prostatectomy in 3 patients, to spinal trauma in 3, and to myelodysplasia in 6 patients. In 3 patients augmentation ileocystoplasty was added to the procedure because of reduced bladder capacity and compliance. Needle suspension of the sling simplified the procedure and obviated difficult retroprostatic dissection. After an average of 13 months 10 out of 11 patients were totally dry, 2 of these are voiding spontaneously with little residual while the rest are on intermittent catheterization. One patient is still wet because of severe postoperative detrusor instability. Urethral erosion occurred in one patient in whom the sling was removed. No upper tract deterioration was found until the last follow-up. In conclusion, a rectus fascia sling is a readily available alternative to the artificial urinary sphincter with comparable success and less reoperation rates. Needle suspension of the sling simplified its application in male patients.