Efficacy Of Artificial Urinary Sphincter Implantation After Failed Bone-Anchored Male Sling For Postprostatectomy Incontinence

Main Category: Urology / Nephrology
Also Included In: Men's health
Article Date: 08 Feb 2008 - 0:00 PDT

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UroToday.com - Bone Anchored Male sling (BAMS) has been popular in the treatment of mild-moderate post-prostatectomy incontinence but no recommendation has been made in the literature after a failed sling surgery.

This is the first report published on this regarding efficacy and role of Artificial Urinary Sphincter (AUS) implantation after a failed sling. We reviewed our data on male sling and identified patients (n=18) who failed initial surgery. All these patients were offered AUS. Only 11 patients agreed and underwent AUS. We report our experience with feasibility and efficacy of AUS in these patients. We found no technical difficulties in urethral dissection.The surgery can be performed easily through the old perineal incision. We did cut the sling in midline in all patients.The AUS cuff can also be placed proximal to the sling without cutting the sling.There is usually intense scarring from the sling but after the initial incision and dissection the peri-urethral planes are preserved for easy dissection for placement of cuff. There was no urethral injuries. Since we use demal graft in addition to polypropylene mesh interposed between urethra and the the mesh. It probably protects the urethra and helps in the preservation of these planes. We achieved the similar outcome as seen in virgin AUS results reported in the literature. Similarly, patient satisfaction was comparable to naive AUS placement.Based on our results, it will be helpful to counsel patients especially if they are contemplating sling procedure that excellent results still can be achieved with future AUS placement if their initial sling surgery fails.

Written by

Ajay Singla MD,FACS,FRCS,FICS, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

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