Rectus Fascia Sling for the Treatment of Total Urethral Incontinence in Males

Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this study. A rectangular rectus sheath flap was harvested and defatted.The flap was placed around the bulbar urethra and sutures were passed both in front of and behindthe pubic bone. Both sutures on each side were tied to each other over the pubic bone. Results: Of the 14 patients, 9 (64.3%) were completely dry, 3 (21.4%) reported improved continence, while 2 (14.3 %) were a failure. In total, 71.4% of the patients showed significant improvement using the Incontinence Quality of Life (IQoL) questionnaire. A significant decrease in the number of pads used per day of 61.3 % (p <0.05) was found and the mean abdominal leak point pressure significantly improved by 43.7 cm H2O (p <0.05). Conclusion: The technique is simple, safe and effective. It allows compression of the urethra against a bony structure, thus causing adequate and maintained closure of the bulbar urethra. It offers a comparable success rate to other sling techniques.