Fascial slings and bladder neck tapering in the treatment of male neurogenic incontinence.

Intractable incontinence in selected male patients with a neurogenic bladder has been treated by increasing bladder compliance with augmentation cystoplasty and increasing urethral resistance with the artificial urinary sphincter. However, there are a number of complications associated with the use of an artificial urinary sphincter. As an alternative, we performed bladder neck tapering and bladder neck slings in 13 men with a neurogenic bladder and an incompetent urethra (10 with spina bifida and 3 with spinal cord injury) undergoing bladder augmentation. Mean patient age was 27 years (range 17 to 40 years) and mean followup was 34.3 months (range 5.5 to 49 months). Postoperatively, there was a 113% increase in mean bladder capacity (from 260 to 550 cc) and a 62% decrease in mean bladder pressure at capacity (from 53 to 20 cm. water). The earliest 2 patients with a Marlex sling suffered erosions that were treated with transurethral excision. As a result, the 11 subsequent patients had a rectus fascial sling. Nine patients (69.2%) are completely dry on self-catheterization, 2 (15.4%) required collagen injections for improved continence and 2 failures (15.4%) required additional procedures. The complications in these patients are comparable to, if not better than, the use of an artificial urinary sphincter. We conclude that a fascial sling with bladder neck tapering is an excellent alternative to the artificial urinary sphincter in the treatment of male neurogenic bladder with an incompetent urethra.