The incidence of post-prostatectomy incontinence (PPI), whether TURP, TURis, or HOlep, ranges from 6.9 to 3.8% after 1 to 18 months postoperative (1). The treatment of PPI ranges from Pelvic floor muscle training to an artificial urinary sphincter. The use of sling techniques is becoming increasingly popular.
Our technique was described in 2007 (2). Since then, over 200 cases have been performed with this technique in different indications. We have published our 2-year follow-up of a composite of cases 16 years ago(3).
Herein, we evaluate cases who had a minimum follow-up of 1 year after TURP, TURis, or HoLEP.

This is a retrospective study. We looked into the database of the hospital for men who underwent retropubic bulbourethral sling (Mansoura technique) following ablation of obstructing BPH. The 3 most commonly applied techniques (TRUP, TURis, and HOlep) were included. Noe had prostatic adenocarcinoma, and all had at least 6 months of postoperative pelvic floor muscle training

52 patients with a mean age of 67 years ± 12 years. All had a retro-public bulbar urethral sling as previously described. Follow-up range was 1-7 years (median: 4 years). At baseline, the average number of pads was 5. 27 patients had HoLEP, and 25 had either TURP or TURis.
At the end of follow-up, 30 patients were dry with a negative 1-hour pad test and no pad usage. 11 patients had retightening of the sling in the first 6 months postoperative, and 2 had a redo sling. 
5 patients were incontinent at the end of follow up. 3 had stress incontinence and were using no or 1 pad per day, while 2 had urge incontinence and were maintained on antimuscarinic.

The sling material is made of commercially available polypropylene meshes used for hernia repair, and the suspending strings were made of  # 1 Prolene sutures
The size of the mesh is chosen based on the width of the bulbospongiosus muscles around the bulbar urethra, and this makes the sling technique versatile. This allows for different sizes of the urethral bulb to be managed.
The feasibility of retightening under local anaesthesia is another advantage of the technique.

Our retopuplic bulbourethral sling is a valid option for post-prostatectomy incontinence.  It is a customizable, cost-effective, and readjustable technique

Mwafulirwa Z, Goodrich K, Roane A, Andrew A, Lerner LB. Utilization of Real-World Evidence in the Evaluation of Post-Surgical Incontinence in Men Undergoing Surgical Treatment for Benign Prostatic Hyperplasia. Prostate. 2026 Mar 1. doi: 10.1002/pros.70146. Epub ahead of print. PMID: 41764777.
Wadie BS. A novel technique of bulbourethral sling for post-prostatectomy incontinence. Scand J Urol Nephrol. 2007;41(5):398-402. doi: 10.1080/00365590701304023. Epub 2007 Apr 16. PMID: 17853033.
Wadie BS. Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. J Urol. 2010 Dec;184(6):2446-51. doi: 10.1016/j.juro.2010.08.032. Epub 2010 Oct 16. PMID: 20952002.