Radical cystectomy and orthotopic diversion is the surgical treatment of ‎choice in men with muscle-invasive bladder cancer. Sphincter-deficiency ‎incontinence is a drastic consequence. While not life-threatening, it could ‎have a significantly negative impact on a patient’s quality of life. The ‎treatment of such complications is daunting. ‎In a study by Steers W. D 1 including 2238 patients with various forms of ‎the orthotopic neobladder, daytime incontinence was reported to be an ‎average of 13% of patients ‎. In another study 2 based on a mailed ‎questionnaire, 139 of 179 responders used pads at least sometimes; half of ‎them used pads day and night.‎ This trial entails the application ‎of a highly customizable perineal sling in the treatment of post-cystectomy ‎incontinence

Men after Radical cystectomy and orthotopic diversion (RCOD) with significant daytime incontinence (defined as the use of 5 pads more at least or wearing an external collecting ‎device during daytime) ‎were included. ‎MRI, basic laboratory testing, and a 1-hour pad test were requested. Tailored ‎to the size of the patient’s bulb, Polypropylene mesh is prepared and fixed ‎by 4 No 1. Ethilon sutures were fixed to the inferior pubic ramus on both sides. ‎The tightening of the sling was carried out under a cough test. ‎

‎10 patients have completed 6 months follow-up. The patients’ mean age was 66 ‎years. (56-80 years). Two of these patients had nerve-sparing cystectomy. ‎No evidence of local recurrence on abdominal-pelvic MRI prior to sling. ‎Mean BMI was 25.62 (range: 22-32.4) Mean pad weight gain was 112.5 ‎gm. (80-200). 6 months after surgery, the pad test was negative in 5 patients ‎‎(50%) and positive in 5. The mean increase of pad weight was 14.1 gm. (range ‎‎1-80 gm.). Mean PVR was 17.1 ml (range: 1-82). Average pad use was 2 ‎pads /day (1-3). ‎

We utilized Polypropylene as well, being a non-absorbable material that is ‎commonly used in different male slings. Our technique is customizable as it ‎was noted that the size of the bulbospongiosus muscles varies from one to ‎another 3‎ ‎. Hence, the importance of the sling being “tailored: to the proper ‎size of the muscle of every particular patient. Using direct fixation of the ‎sling using 5/8 circle robust needle of Ethilon 1 suture; with direct bite into ‎the inferior pubic ramus cortex with the help of a curved strong needle ‎holder is more time and money-saving than the bone screws and their ‎special drill. ‎

In the short term and based on a small sample, the customized perineal sling ‎described is a safe, easy-to-learn, and effective mode of treatment of post- ‎cystectomy incontinence.‎

Steers WD.: Voiding dysfunction in the orthotopic neobladder. World J ?Urol. 2000; 18(5):330.?
Ahmadi H, Skinner EC, Simma-Chiang V, et al. Urinary functional ?outcome following radical cystoprostatectomy and ileal neobladder ?reconstruction in male patients. J Urol. 2013; 189 (5):1782.?
Peikert K, Platzek I, Bessède T et al: The male bulbospongiosus muscle ?and its relation to the external anal sphincter. J Urol. 2015; 193(4):1433.?