A recent report by S. V. Romano, F. Nakamura and colleagues from Argentina and Brazil describes the efficacy and safety of a new adjustable bulbourethral sling for male stress incontinence after prostate surgery. The report of this multicenter trial is published in the February 2006 issue of BJU International.

The new sling has three components: the pad, a 4.2 X 2.6 X 0.9 cm thick silicone foam cushion designed to provide soft compression of the bulbar urethra, the silicone tubing connected to the pad is comprised of multiple cone-like sections that allow it to be pulled through silicone washers to adjust the tension of the sling. The operation is similar to that described by Schaeffer for the original bulbourethral sling. The perineal membrane lateral to the bulbar urethra and medial to the ischiopubic ramus is exposed and punctured with a special tool that is then passed suprapubically behind the pubic ramus and through the rectus fascia and out of the skin- much like a TVT would be placed in a woman. The pad and its silicone connection tubing is connected to the tool and pulled up. The silicone washers are placed on the tubing and the sling tension is adjusted to provide an absence of flow at a retrograde perfusion pressure of 45 cm of H2O. The silicone washers are buried on the fascia under the skin and the two suprapubic and one perineal incisions are closed.

The procedure was performed on 48 men with SUI over a one and a half year period. All men reported moderate to severe SUI for > 1 year after radical prostatectomy (39) or after surgery for benign disease (9). Of the 48 men, 19 wore an average of 5 pads/day, and 29 used a penile clamp or a condom catheter preoperatively. The mean follow-up was 7.5 months and in 30 men (63%) it was >6 months. Results showed that before and after surgery, the mean retrograde perfusion pressure was 23.5 and 47.5 cm of H2O. Overall, SUI was cured (dry, no pads) in 35 (73%) patients, and improved in five (10%; mild sporadic incontinence, one or fewer pads/day). The treatment failed in eight patients (17%, more than 2 pads a day), despite readjustment in 3 (6%) and loosening in one. The sling was removed in thee patients (6%) due to urethral erosion and in two (4%) due to infection.

The early results of this new sling are encouraging and with acceptable complication rates this procedure may provide another valid alternative to the artificial urinary sphincter for men with stress urinary incontinence after prostate surgery.

BJU Int. 2006 Mar; 97(3):533-39