PURPOSE: We retrospectively report objective and subjective outcomes in 40 male 
patients who underwent bone anchored suburethral synthetic sling positioning for 
stress urinary incontinence due to intrinsic sphincter deficiency.
MATERIALS AND METHODS: Patients with stress urinary incontinence due to radical 
retropubic prostatectomy (32), robot assisted laparoscopic prostatectomy (3) and 
transurethral prostate resection (5) underwent bone anchored suburethral 
synthetic sling positioning between December 2002 and December 2007. Mean 
followup was 35.2 months (range 2 to 62). Previous anti-incontinence procedures, 
radiotherapy and transurethral procedures due to urethral stricture were 
performed in 5, 11 and 5 patients, respectively. Before and after surgery 
patients were evaluated by physical examination, urethral cystoscopy, 
urodynamics, a 1-hour pad test and a quality of life questionnaire. Patients 
were stratified into 3 groups, including group 1-cured (dry with a pad weight of 
0 to 1 gm), group 2-improved (mild to moderate incontinence with a pad weight of 
2 to 50 gm) and group 3-failed (patient condition unchanged with a pad weight of 
greater than 50 gm).
RESULTS: At the final followup visit 22 (55%), 5 (12.5%) and 13 patients (32.5%) 
were cured, improved and failed, respectively. Mean pad weight significantly 
decreased to 51.3 gm in 54% of cases, while the mean total questionnaire score 
significantly increased to 72.9 in 65% and abdominal leak point pressure 
significantly increased to 92.5 cm H(2)O in 52%. Statistical analysis showed a 
significant association between preoperative radiotherapy and treatment failure 
(85% of patients). Complications were perineal pain in 73% of cases, detrusor 
overactivity in 5% and sling infection in 15%.
CONCLUSIONS: The bone anchored suburethral synthetic sling is a simple and 
attractive procedure that can produce immediate good results with low morbidity, 
especially when strictly selected patients are treated. Radiotherapy remains a 
strong predictor of failure.