Bone-anchored sling for male stress urinary incontinence: assessment of complications.

Objectives: To evaluate the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency.

Methods: We retrospectively reviewed 119 men who had undergone 140 BAS procedures for SUI from May 2000 to May 2009 at our institution. All complications were recorded during the follow-up visits. Pad test and questionnaire results were recorded, as available.

Results: BAS was performed in 140 cases for 119 men with SUI. Mean patient age was 65.8 years (range 23-89). Main etiologies for SUI included previous treatment of prostate cancer (82.4%), neurologic dysfunction (12.6%), and previous transurethral resection of the prostate (3.6%). Recurrent SUI, de novo urge incontinence, and wound infection were the most frequent complications encountered (25.2%, 17.6%, and 16%, respectively). The 3 most common reasons for reoperation included bulking agent injection for recurrent SUI (5.9%), sling revision for bone screw dislodgement (5.9%), and sling revision for recurrent SUI (5.0%). Overall complication and reoperation rate for the index cases was 58.8% and 26.9%, respectively.

Conclusions: The incidence of complications after male BAS placement might be greater than previously reported. Patient counseling before surgery regarding the potential complications is important. Men treated for prostate cancer should be informed of the risk of recurrent SUI. In appropriately selected patients, we believe the BAS is a reasonable surgical option; however, the risk of postoperative complication is not equivocal.