Men with invasive bladder cancer who underwent radical cystectomy and orthotopic diversion might have bothersome urine incontinence following surgery. The use of injectables was met with very limited success. The insertion of artificial sphincter is both expensive and associated with significant adverse events especially in patients who already had major radical surgery and likely to develop local recurrence at any stage. We tried a home- devised perineal sling to correct this condition.

This is a clinical surgical trial. We enrolled patients with significant post-cystoprostatectomy incontinence in whom the following criteria are met:
1-	No evidence of local recurrence
2-	Willing to provide informed consent to surgery
3-	Acceptable performance status
4-	PVR < 50 ml
5-	Able to perform CIC, if needed
Local examination as well as pelvis MRI revealed no evidence of local recurrence. After urethroscopy, the urethra and the ileal pouch are examined under spinal anastheisa. Shot inverted U perineal incision was done. Identification of the bulbar urethra within its covering muscles was achieved. A double-faced polypropylene mesh was used as a sing. 4 sutures No. 1 Nylon were taken in the inferior pubic rami; 2 on each side. Figure 1 shows 4 Nylon 1 sutures anchored to the bone through ischicavernopsus muscles. Figure 2 shows the sling in its final position. The sling was fastened to Nylon sutures and tightened while the patient was asked to cough. Foley catheter and Yeates drain were left for 1 day.

So far, five men were included in the study. Mean age is 73 years, all of them have been using external collecting device (Condom catheter) to keep dry. Mean increase in 1- hour pad test is +70 gm. Mean operative time was 72 minutes and average blood loss was 15 ml. All patients were discharged next day after taking out the drain.

At 1st follow up visit; within 2 weeks of surgery all but one had good healing with mild to moderate local pain. In 1 patient, wound disruption was notice. Only skin was dehiscent. Simple sutures under local anaethesia were sufficient. 
At 6 months, all had been dry and not using pads. In 2, voiding by Crede was associated with PVR more than 50 and less than 200.
In 1 patient, mild stress incontinence was observed at times of significant cough or sneeze but the patient was not bothered to wear on pads

In this subset of patients with significant incontinence after radical cystoprostatectomy, options are quite scarce. This simple and economic procedure is providing very promising results. Larger cohorts and longer follow up are underway.