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Outpatient perineal sling in adolescent boys with neurogenic incontinence.
J Urol. 2009 Oct; 182(4 Suppl):1792-6.JU

Abstract

PURPOSE

Management for urinary incontinence in boys with sphincteric incompetence secondary to a neurogenic etiology is a challenge. Minimally invasive approaches have inconsistent efficacy and may require multiple treatments. Open bladder neck reconstruction requires inpatient hospitalizations and can be associated with a high complication rate. To overcome some of these shortcomings we placed a polypropylene male perineal sling in male adolescents with neurogenic sphincteric incontinence. We retrospectively reviewed the outcome in our initial 6 patients.

MATERIALS AND METHODS

Six patients 14 to 20 years old underwent placement of a polypropylene male perineal sling on an outpatient basis. Followup was 27 to 39 months (median 33). All patients had a history of myelomeningocele and underwent urodynamics showing normal compliance, adequate capacity and sphincteric incompetence. A suburethral sling was placed on an outpatient basis through a small perineal incision. Sling tension was adjusted for maximal urethral compression while still permitting uncomplicated urethral catheter passage.

RESULTS

All 6 patients reported immediate complete continence after sling placement. Two slings were removed after local infection developed and 1 was replaced. Another sling required revision secondary to incomplete bone anchor fixation. No patients had urethral erosion. All 5 patients with a sling currently in place were fully continent on intermittent catheterization every 3 hours and they reported excellent satisfaction with the procedure.

CONCLUSIONS

Our retrospective study suggests that the male urethral sling may be an outpatient option for neurogenic incontinence secondary to sphincteric incompetence. Long-term followup in our initial 6 patients shows encouraging durability. Continued study is required to determine strategies that might decrease the complication rate of this approach.

Authors+Show Affiliations

Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. gregoryedean@gmail.comNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19692039

Citation

Dean, Gregory E., and David A. Kunkle. "Outpatient Perineal Sling in Adolescent Boys With Neurogenic Incontinence." The Journal of Urology, vol. 182, no. 4 Suppl, 2009, pp. 1792-6.
Dean GE, Kunkle DA. Outpatient perineal sling in adolescent boys with neurogenic incontinence. J Urol. 2009;182(4 Suppl):1792-6.
Dean, G. E., & Kunkle, D. A. (2009). Outpatient perineal sling in adolescent boys with neurogenic incontinence. The Journal of Urology, 182(4 Suppl), 1792-6. https://doi.org/10.1016/j.juro.2009.04.082
Dean GE, Kunkle DA. Outpatient Perineal Sling in Adolescent Boys With Neurogenic Incontinence. J Urol. 2009;182(4 Suppl):1792-6. PubMed PMID: 19692039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outpatient perineal sling in adolescent boys with neurogenic incontinence. AU - Dean,Gregory E, AU - Kunkle,David A, Y1 - 2009/08/18/ PY - 2008/12/02/received PY - 2009/8/21/entrez PY - 2009/8/21/pubmed PY - 2009/10/30/medline SP - 1792 EP - 6 JF - The Journal of urology JO - J Urol VL - 182 IS - 4 Suppl N2 - PURPOSE: Management for urinary incontinence in boys with sphincteric incompetence secondary to a neurogenic etiology is a challenge. Minimally invasive approaches have inconsistent efficacy and may require multiple treatments. Open bladder neck reconstruction requires inpatient hospitalizations and can be associated with a high complication rate. To overcome some of these shortcomings we placed a polypropylene male perineal sling in male adolescents with neurogenic sphincteric incontinence. We retrospectively reviewed the outcome in our initial 6 patients. MATERIALS AND METHODS: Six patients 14 to 20 years old underwent placement of a polypropylene male perineal sling on an outpatient basis. Followup was 27 to 39 months (median 33). All patients had a history of myelomeningocele and underwent urodynamics showing normal compliance, adequate capacity and sphincteric incompetence. A suburethral sling was placed on an outpatient basis through a small perineal incision. Sling tension was adjusted for maximal urethral compression while still permitting uncomplicated urethral catheter passage. RESULTS: All 6 patients reported immediate complete continence after sling placement. Two slings were removed after local infection developed and 1 was replaced. Another sling required revision secondary to incomplete bone anchor fixation. No patients had urethral erosion. All 5 patients with a sling currently in place were fully continent on intermittent catheterization every 3 hours and they reported excellent satisfaction with the procedure. CONCLUSIONS: Our retrospective study suggests that the male urethral sling may be an outpatient option for neurogenic incontinence secondary to sphincteric incompetence. Long-term followup in our initial 6 patients shows encouraging durability. Continued study is required to determine strategies that might decrease the complication rate of this approach. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/19692039/Outpatient_perineal_sling_in_adolescent_boys_with_neurogenic_incontinence_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2009.04.082?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -