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Erosion of a male polypropylene sling.

A 40-year-old male had development of neurogenic stress urinary incontinence after resection of a lumbar lipomeningomyelocele in 1975. A modified cystometrogram demonstrated a capacity of 450 cc and leakage with Valsalva maneuver at 200 cc and 450 cc. Two periurethral collagen injections were unsuccessful. Standard transperineal placement of polypropylene male urethral sling was performed. Care was taken to ensure that the bone anchors were placed securely. Under visual and tactile inspection the sling was placed directly around the bulbospongiosus muscle with a 14Fr indwelling urethral catheter draining the bladder. Two trials of void on postoperative days 7 and 14 resulted in acute urinary retention, necessitating extended catheter drainage. After the second failure cystourethroscopy showed that the sling had eroded into the bulbous urethra. The perineal incision was explored and the sling was removed. The incision did not appear to be infected, and intraoperative cultures were negative. The sling and 2 bone anchors were removed, and a necrotic portion of the dorsal urethra was resected. After a urethral catheter was placed in the bladder over a guidewire the perineal incision was closed in an interrupted fashion to heal via secondary intention. The perineal incision healed but the patient had development of a dense, long segment, bulbar urethral stricture. DISCUSSION