Ajay Singla, Neelesh Aggarwal

Wayne State University, Detroit, Michigan

Introduction and Objectives: Since its introduction in 2001¹, Bone anchored male sling (BAMS) has emerged as an effective alternative procedure in mild to moderate post-prostatectomy incontinence. We had previously reported short term results of BAMS². In the present study, we report our five years experience with this procedure.

Methods: From 2001-2006, a total of 87 patients underwent bone anchored male sling. Eighty three patients underwent radical prostatectomy or radiation therapy for prostate cancer, three had neurogenic bladder and one patient had pelvic trauma. Absorbable biomaterial was used for male sling in first 16 patients and 77 patients had composite graft (mesh with dermis). A total of 60(68.9%) had mild-moderate (1-3 pads) and 27(31.1%) had severe (>3pads) incontinence. Urodynamic evaluation was performed in all patients to determine valsalva leak point pressure (VLPP), maximal flow rate (Q Max) and post voiding residual volumes (PVR) and the presence of detrusor overactivity (DO). UCLA/RAND questionnaire scoring was used pre and post operatively to evaluate the outcome of the procedure.

Results Obtained: The mean age of the patients was 65.5 (range 30-81) years. The mean follow up period was 36 (range 6- 60) months. There were no intra-operative complications related to the surgery. No urethral erosions were seen. Sling infection occurred in 2 patients which were treated with sling removal. None of the patients went into permanent urinary retention. SUI was cured in 44 (52.87%) and significantly improved in another 22 (25.29%) patients with a cured/improved rate of 78.16%. A total of 19(21.8%) patients failed the procedure. All these patients had either severe incontinence pre-operatively or absorbable biomaterial was used as sling material. The post-operative urodynamic study in failed patients revealed SUI with low valsalva leak pressures. Thirteen of these failed patients later underwent artificial urinary sphincter placement with good results. Sling was removed in 2(2.3%) patients secondary to mesh infection.

Conclusions: As seen in prior short term studies, non-absorbable bone anchored male sling still remains a safe and effective treatment in men with mild-moderate SUI.

References:

1. Madjar, S., Jacoby, K., Giberti, C. et al: Bone anchored sling for the treatment of post-prostatectomy incontinence. J urol, 165: 72, 2001
2. Rami Onur, Atul D. Rajpurkar, Ajay Singla, “New Perineal Bone Anchored Male Sling: Lessons Learned” Urology 64 (1), 58-61, 2004

Note: No funding obtained for this project.

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