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A NOVEL PERINEAL SLING TECHNIQUE USING ANTERIOR TIBIALIS TENDON
ALLOGRAFT AND ORTHOPEDIC ISCHIAL BONE ANCHORS
Charles CONCODORA
1
, Laura GIUSTO
1
, Michael PACKER
2
, Martin HERMAN
3
and Gregory DEAN
2
1) Temple University Hospital, Urology, Philadelphia, USA - 2) Urology for Children, Urology, Voorhees Township, USA -
3) St Christopher's Hospital for Children, Urology, Philadelphia, USA
PURPOSE
Management of urinary symptoms in pediatric patients with neurogenic bladder and incompetent bladder neck offers a
complex challenge to pediatric urologists. In our experience with manufactured bulbar urethral compressive sling kits to
treat urinary incontinence of these patients we have recognized bone anchor displacement due to “pull-back” effect,
resulting in failure of the sling and persistent incontinence. An alternate combination of sling material and bone anchor
to reduce anchor failure was sought. We describe a novel perineal sling technique utilizing more robust materials
typically used in orthopedic reconstructive surgery including anterior tibialis tendon allograft and ischial bone anchors.
MATERIAL AND METHODS
Our technique was performed on an 11-year-old male with neurogenic bladder and open bladder neck. Patient is placed
in lithotomy position. An incision was made in the perineum followed by lateral subcutaneous tissue dissection towards
the ischium. Once fluoroscopy confirmed pelvic bone landmarks, Arthrex® Corkscrew FT II Suture Anchors with a 5.5 x
15mm Titanium screw and double loaded #2 Fiberwires were used under fluoroscopic guidance to place bilateral, single
ischial bone anchors. Anterior tibialis tendon allograft was sutured in place by taking wide bites perpendicular to the
grain of the tendinous fibers and securely tied down to the bone anchor. Proper tension of the allograft and compression
of the urethra was obtained and confirmed by catheter placement and cystoscopy. The catheter was easily inserted,
cystoscopy demonstrated coaptation of the bulbar urethra.
RESULTS
Operative time for our index case was 185 minutes with minimal blood loss. The patient was discharged home on post-
operative day one. At five-week follow-up, patient was dry in between catheterizations. There were no peri-operative
complications and no post-operative complications to date.
CONCLUSIONS
Use of anterior tibialis tendon allograft in conjunction with Arthrex® ischial bone anchors to treat incompetent bladder
neck is a safe and feasible technique.