Periurethral and puboprostatic sling repair for incontinence in patients with myelodysplasia.

The surgical management of sphincteric incompetence in patients with myelodysplasia is a formidable problem. In 10 female patients and 4 male patients with myelodysplasia a free graft of rectus fascia was used to suspend the urethra, termed the periurethral and puboprostatic sling procedures, respectively. All but 1 patient also underwent augmentation cystoplasty, usually with sigmoid colon. Patient age ranged from 7 to 25 years (mean 12.6 years) and followup ranged from 2 to 27 months (mean 12 months). Of the patients 12 are completely dry on clean intermittent catheterization, 1 has undergone 2 subsequent urethral suspension procedures but remains incontinent and 1 experiences nocturnal enuresis but is dry during the day. The periurethral sling appears to be as effective as the artificial urinary sphincter, the Young-Dees-Leadbetter bladder neck reconstruction and the Kropp procedure in the management of sphincteric incompetence in female patients. In male patients experience with the puboprostatic sling is limited but thus far it is encouraging.