Abstract:
A method of treating urinary incontinence includes forming a first incision exposing a urethral region a patient and forming first and second suprapubic incisions. The method includes tunneling an introducer from the first suprapubic incision superficially anterior to a pubic symphysis of the patient and out of the first incision, attaching a first portion of an implant to the introducer and retracting the introducer and the first portion of the implant from the first incision to the first suprapubic incision, and repeating these maneuvers on the contralateral side. The method includes forming third and fourth incisions and tunneling a suitable introducer from the third/fourth incisions through separate obturator foramen of the patient to allow retracting portions of the implant from the first incision back through to the third/fourth incision with the introducer.

Description:
CLAIM OF BENEFIT TO EARLIER-FILED APPLICATIONS 
     This application is a divisional of and claims the benefit of U.S. application Ser. No. 11/552,484 filed on Oct. 24, 2006, entitled Implantable Sling for the Treatment of Male Incontinence and Method of Using the Same, which is both a continuation of PCT Application PCT/US2006/016709 having Publ. No. WO 2007/00825 filed on Apr. 28, 2006 and a divisional of U.S. application Ser. No. 11/119,446 filed on Apr. 30, 2005, now issued as U.S. Pat. No. 7,431,690, and likewise entitled Implantable Sling for the Treatment of Male Incontinence and Method of Using the Same. 
    
    
     STATEMENT RE: FEDERALLY SPONSORED RESEARCH/DEVELOPMENT 
     Not Applicable 
     BACKGROUND 
     The present invention is directed to surgical implants for the treatment of male incontinence, and in particular, implantable slings that are operative to provide sling-type support at or distal to the bulbar urethral region of a patient and operatively anchored into position via fixation about the patient&#39;s descending rami. 
     Of the estimated 19 million North American adults who have urinary incontinence, 20% are estimated to be men. Such condition can range in severity from partial to complete loss of bladder control and patients afflicted with urinary incontinence can experience varying degrees of urine loss. In addition, it is known that urinary incontinence may change over time and that men with light incontinence, for example, may experience minimal leakage during the occurrence of a provocative event, such as laughing or coughing, whereas men with heavy incontinence may experience continuous urine leakage. 
     Generally, male urinary incontinence is not considered a disease, but rather a symptom or side effect of another medical condition. Among the causes known to cause urinary incontinence include prostate surgery, and in particular total prostatectomy, head and spinal cord injury, infection, certain toxins, such as too much alcohol consumption, certain medications, such as sedating medications, and certain diseases, such as cancer, Parkinson&#39;s disease and multiple sclerosis. Indeed, male incontinence can be caused simply by virtue of the aging process or emotional distress. 
     Each case of male incontinence, however, is unique and no two men are affected by incontinence in the same way. There are, however, well-recognized types of incontinence and various ways to treat the same. Stress incontinence, which is the most common type of incontinence, wherein urine leakage occurs during the occurrence of a provocative event, such as sneezing, laughing, lifting heavy objects, or when the patient engages in any type of exercise that puts pressure on the bladder. Urge incontinence occurs when the patient wants to urinate but is incapable of exercising restraint until reaching a restroom. Additional types of incontinence include overflow incontinence, which occurs when the quantity of urine exceeds the capacity of the patient&#39;s bladder, and functional incontinence, which occurs when the patient has knowledge of the need to urinate but simply cannot access a restroom quickly enough due to a physical obstruction or debilitation. 
     To treat male urinary incontinence, several options are available. Among the more effective types of recognized treatment include behavioral techniques, such as biofeedback, bladder training, and pelvic muscle exercises, and modifications of the patient&#39;s diet and fluid intake. With respect to the latter, it is known that eliminating or cutting back on certain types of substances, such as caffeine and alcohol, can help alleviate incontinence. There are additionally medications available, such as dicyclomine (Bentyl), flavoxate (Urispas), hyoscyamine sulfate (Anaspaz), imipramine (Tofranil), oxybutynin (Ditropan), tolterodine (Detrol), and propantheline (Pro-Banthine), phenylpropanolamine (Dexatrim), and pseudoephedrine (Sudafed) that are helpful in controlling urinary incontinence. 
     Surgery may additionally be an option to treat male urinary incontinence. Along these lines, surgical implants, such as the In-Vance, produced by American Medical Systems, Inc., of Minneapolis, Minn., is a commercially available surgical implant that is operative to provide structural support to the urethra for the treatment of stress incontinence. In this regard, the implant is operative to provide structural support to the urethra such that during a provocative event, the implant will provide structural support to the urethra thus causing the urine to be retained within the bladder and not leak through the urethra. 
     With respect to utilizing sling implants to treat male incontinence, however, such approach has numerous drawbacks. Due to the differences between male and female anatomy, to secure sub urethral sling implants into position typically requires the use of bone screws, which are well-known in the art to be difficult and time consuming to deploy, and can result in significant patient discomfort, especially within the first couple of weeks following the surgical implantation. In addition, implanting suburethral slings are often times difficult to secure into position with the optimal degree of tension. Indeed, the implantation of suburethral slings for the treatment of male incontinence is well-recognized as complex, time consuming and can produce suboptimal clinical outcomes. Moreover, it is well recognized among urologists performing such implant procedures that sutures attached to bone anchors and or bone screws utilized to secure the sling into position frequently break and that often times additional bone screws must be secured into position. In fact, each suture attached to bone anchors and or bone screws must typically be retensioned two to three times before optimal sling positioning and structural support to the urethra is achieved. 
     Accordingly, there is a substantial need in the art for a suburethral sling implant for the treatment of male incontinence that is substantially easier to surgically secure into position and that can further provide an optimal degree of urethral support to thus effectively treat male urinary incontinence. There is additionally a need in the art for an implant that is of simple construction, easy to surgically manipulate, and can be manufactured at relative low cost utilizing known implant materials, whether it be synthetic materials, natural tissues, or combinations thereof. There is yet a further need in the art for such an implant that can be secured into position such that the implant defines a suburethral sling portion operatively positioned at or distal to the bulbar urethra of the patient that remains anchored into position via the use of an anchoring portion that extends through the obturator foramen and remain secured at or near the descending rami of the patient&#39;s pelvis without the use of bone anchors. With respect to the latter, it would be exceptionally advantageous for such a surgical implant that could be anchored to the pubis through the obturator foramen preferably via the descending rami thereof. 
     BRIEF SUMMARY 
     The present invention specifically addresses and alleviates the above-identified deficiencies in the art. In this regard, the present invention is directed to sub urethral sling implants and methods of deploying the same that are effective and substantially easier to deploy than prior art implants and implantation techniques for treating male incontinence. The implant comprises the combination of a urethral support portion and at least one anchoring portion. The support portion is operatively positioned at or distal to the bulbar urethra. Per conventional sub urethral slings, the support portion is operative to provide structural support to the urethra such that during the occurrence of a provocative event, the sling is operative to compressively engage the urethra to prevent urine leaking therefrom. The support portion will have a surface area that is at least 2 cm long by 1 cm wide to 8 cm long by 8 cm wide. 
     The anchor portion extends from the support portion. The anchor portion, which may take a variety of configurations, is operative to extend through the obturator foramen of the patient and become secured at a locus preferably at or near the descending ramus. To effectuate such attachment, it is contemplated that one or more sutures may be utilized to ensure that the anchor portion becomes secured about the ramus and that the support portion remains operatively positioned at or distal to the bulbar urethra. In a preferred embodiment, the implant will have at least two anchor portions extending from the support portion with each respective anchor portion extending through the obturator foramen and attachable about respective ones of the patient&#39;s rami. The anchor portions will have a width ranging from between 0.5-4 cm and the length ranging from at least 5.0 cm to 45.0 cm. To the extent necessary, both the support and anchor portions of the implant may be surgically fashioned as necessary to optimize sizing and configuration of the implant to suit the needs of a specific patient. 
     In certain embodiments of the implant of the present invention, the same may take the form of implants having a central support structure with anchoring portions extending therefrom in opposed directions or may be fashioned to have generally “H”, inverted “U”, or “X” shapes. The implants may further be provided as generally rectangular, square or trapezoidal shapes and may further be provided with one or more apertures to accommodate the attachment of sutures, surgical tacks and the like. The implants of the present invention may further be fabricated such that sutures are pre-attached thereto, per the teachings of Applicants&#39; co-owned pending U.S. patent application Ser. No. 10/947,182, entitled READILY IMPLANTABLE SLING, filed Sep. 22, 2004, the teachings of which are expressly incorporated by reference. The implants of the present invention may further be fabricated from any of a variety of surgically compatible materials well-known in the art, including synthetic materials, such as synthetic mesh and the like, as well as natural materials, such as harvested tissues from sources such as animals, cadavers or the patient himself. The implants may further be fabricated such that the same are formed from combinations of materials, including but not limited to combinations of different types of synthetic materials, combinations of different types of natural tissues and/or combinations of both synthetic and natural tissues. 
     Regardless of the embodiment, in all procedures involving the implantation of the implants of the present invention, such procedures are performed with the patient assuming a lithotomy position. A vertical perineal incision is made in the midline dissecting to expose the bulbar urethra and the inferior aspect of the descending rami bilaterally. A surgical introducer is utilized to introduce the implant into position, typically through the obturator foramen, in manner that is substantially easier and less traumatic than conventional surgical procedures utilized to access and implant slings for the treatment of male incontinence. Once the surgical site is accessed and the anchoring portion will preferably be positioned through the obturator foramen and anchored into position. Surgical sutures and the like may be deployed to facilitate anchoring of the anchor portions of the implant. Minor variations well-known to those skilled in the art may necessarily be made to effectuate optimal attachment and positioning of the support portion of the implant, as may be necessary for a given patient. In all cases, however, the surgical procedures and implants of the present invention provide a radically more efficient, effective and less traumatic surgical approach to the treatment of male incontinence. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features and advantages of the various embodiments disclosed herein will be better understood with respect to the following description and drawings, in which like numbers refer to like parts throughout. 
         FIG. 1  is a frontal perspective view of a pelvis, a bladder and a urethra extending therefrom with a sling-type implant shown operatively secured into position, the implant having a support portion aligned at or distal to the bulbar urethra and anchoring portions, the latter shown extending through the obturator foramen and secured about dedicated ones of the rami of each hip bone. 
         FIG. 2  is a side perspective view of the pelvis and implant of  FIG. 1  showing a respective one of the anchor portions of the implant secured about the ramus. 
         FIG. 3  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with the present invention. 
         FIG. 4  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 5  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 6  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 7  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 8  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 9  is a frontal view of an implant for the treatment of male urinary incontinence as constructed in accordance with another embodiment of the present invention. 
         FIG. 10  is a front view of one embodiment of a support and a method of implanting the support relative to a pelvis. 
         FIG. 11  is a side view of the support and the method of implanting the support illustrated in  FIG. 10 . 
     
    
    
     DETAILED DESCRIPTION 
     The above description is given by way of example, and not limitation. Given the above disclosure, one skilled in the art could devise variations that are within the scope and spirit of the invention disclosed herein, including various ways of making and surgically implanting the implants described herein. Further, the various features of the embodiments disclosed herein can be used alone, or in varying combinations with each other and are not intended to be limited to the specific combination described herein. Thus, the scope of the claims is not to be limited by the illustrated embodiments. 
     Referring now to the drawings, initially to  FIG. 1 , there is shown an implant  10  for the treatment of male incontinence that is operative to provide suburethral support to thus prevent the leakage of urine, particularly when the patient experiences a provocative event. In this respect, the implant  10  is operative to act as a sub urethral sling, as is known in the art, but is advantageously operative to be more easily secured into position than prior art sling implants. The implants of the present invention are further capable of being deployed in a manner that is far less traumatic than prior art sling implants and methods of surgically implanting the same, and further utilizing novel attachment approach that provides for optimal suburethral positioning of the sling  10  in an exceptionally secure manner without the use of bone anchors. 
     In its broadest sense, the implants of the present invention comprise the combination of a urethral support portion and at least one anchoring portion. The support portion is operatively positioned at or distal to the bulbar urethra. The anchoring portion is operative to secure the support portion into position to thus provide structural support to the urethra, and particularly so during the occurrence of a provocative event. To achieve that end, the anchoring member is generally operative to extend through the obturator foramen and become secured at at least one and preferably both of the patient&#39;s rami. In preferred embodiments of the invention, discussed more fully below, the anchor portion will be operatively interconnectable with the descending ramus of one of the patient&#39;s pelvis. Advantageously, the positioning of the anchor portion against the descending ramus will be accomplished without the use of bone screws, which are well-known in the art to be problematic to deploy and utilized as an attachment point for sutures and the like. 
     The implants of the present invention further may take a variety of embodiments. In certain of the embodiments depicted, the implant will include first and second attachment portions extending from the support portion with each attachment portion being operatively extensible through the obturator foramen and attachable to respective ones of the patient&#39;s descending rami. Such attachment portions may be operative to extend in opposed directions from the support portion or, alternatively, extend in generally parallel relation to one another from the support portion. In certain other embodiments, the support portion anchoring portion may be formed as a continuous segment or otherwise formed to have a generally rectangular or trapezoidal shape. Moreover, in certain embodiments, the implants of the present invention may incorporate the use of sutures or with other types of surgically implantable structures and the like to facilitate attachment of the same into position. Specifically, it is contemplated that such embodiments may rely upon a combination of structures in combination with certain portions of the implant to facilitate attachment and positioning thereof. 
     For purposes of defining the general parameters of implants of the present invention, it is presently believed that the support portion of the implant will define a surface area ranging from a 1 cm width by 2 cm length to an 8 cm width by 8.0 cm length. With respect to the anchor portion, the same will preferably define a surface area defined by a 0.5 cm width by 5.0 cm length to an area defined by a 4.0 cm width to a 45.0 cm length. With respect to the latter, it should further be understood that certain embodiments of the present invention, discussed more fully below, sutures may be utilized in operative combination with the anchoring portion or, in certain embodiments, exclusively with the support portion, to thus define means for attaching and securing the implant into position. 
     With respect to the fabrication of the implants of the present invention, the same may be made from either synthetic materials, such as surgical mesh and the like, natural tissues, such as tissues harvested from either an animal, cadaverous source or the patient himself, and/or combinations of synthetic and natural materials. Along these lines, it is contemplated that the implants of the present invention can be fabricated consistent with those methods disclosed in Applicant&#39;s co-owned and co-pending U.S. patent application Ser. No. 10/684,861, the teachings of which are expressly incorporated herein by reference. Along these lines, it is further contemplated that in certain embodiments of the present invention, the implants may be prefabricated with slings or sutures attached thereto, consistent with the teachings of Applicants&#39; co-owned pending U.S. patent application Ser. No. 10/947,182, entitled READILY IMPLANT ABLE SLING, the teachings of which are likewise incorporated by reference. 
     Bearing the foregoing principles in mind, a detailed explanation is provided herebelow with respect to the structure, properties and functioning of the implants of the present invention. Referring again to  FIG. 1 , the implant  10  is situated such that the support portion  12  thereof is operatively positioned over the urethra. The implant  10  as depicted includes first and second support portions  14 ,  16  that are shown extending through the obturator foramen  18  and wrapped about dedicated ones of the descending rami  20 ,  22  of hip bones  24 ,  26 , respectively. 
       FIG. 2  more clearly depicts such engagement between a respective one of the anchor portions  14  as extending through the obturator foramen  18  and engaged with descending ramus  20  of hip bone  24 . In this regard, the implants of the present invention generally operate on the principle of including attachment of the implant into position via an anchoring mechanism that extends through the obturator foramen and becoming secured to at least one, and preferably both of the descending ramus of the patient; however, it should be understood that the descending ramus locus is not to limit the scope of the present invention and that attachment to any part of the periphery of the pubis and ischium may be considered suitable areas to which the implants of the present invention may be attached. Accordingly, fixation of the anchor portions at the descending rami or any other structure should not be deemed limiting in any respect. 
     Bearing the foregoing principles in mind, and referring now to remaining  FIGS. 3-9 , there are shown various embodiments of the implants of the present invention. Referring initially to  FIG. 3 , implant  300  is defined by support portion  302  with anchor portions  304 ,  306  extending in opposed directions therefrom. According to a preferred embodiment, support portion will have a width “A” of approximately 4 cm and a length “B” of approximately 6 cm. Anchor portions  304 ,  306  may extend from support portion  302  via a tapered segment, as shown, and will have a length “C” of approximately 15 cm and a width “D” of approximately 2 cm. As discussed above, the implant  300  may be fabricated from either synthetic and/or natural materials. It should be understood, however, that the specific dimensions provided herein are not absolute, and variations in the length and width of both the support portion  302  and anchor portions  304 ,  306  can be readily made by those skilled in the art. Along these lines, it should be understood that the specific dimensions provided herein can vary by 50% or substantially greater, as discussed above, and retain its ability for use as an implant. 
     With respect to the procedure for implanting the implant  300  depicted in  FIG. 3 , Applicants believe that the best mode for performing the same will require the patient to assume a lithotomy position. A vertical perineal incision will be made in the midline dissecting to expose the bulbar urethra in the inferior aspect of the descending rami bilaterally. A suitable introducer is then passed from inside out or outside in through the upper aspect of the obturator foramen. A suture that is attached to a respective one of the anchor portions  304  or  306  is threaded through the introducer. The introducer is then retracted and the suture is pulled until a respective one of the ends of the anchor portion  304  or  306  to which the suture is attached can be grasped. The support portion  302  is then carried over the bulbar urethral complex and, thereafter, a second introducer is passed from inside out or outside in on the contra-lateral side to thus enable the second other respective anchor portion extends through the obturator foramen. The second introducer is then retracted and a suture affixed to the respective other anchor portion extends around the pubic ramus. Once so positioned, tension is introduced to the implant  300  such that the support portion  302  thereof achieves optimal suburethral compression. The respective ends of anchor portions  304 ,  306  are then secured, preferably via attachment to support portion  302  at the edge of each pubic ramus. To achieve that end, it is contemplated that a suture with or without an additional tensioning disc (not shown) is passed through anchor portions  304 ,  306  to effectuate such attachment. 
     Referring now to  FIG. 4 , there is shown a further embodiment  400  for use in the surgical treatment of male urinary incontinence. As depicted, the implant  400  includes a support portion  402  with first and second anchor portions  404 ,  406  depending therefrom in generally parallel relation to one another and additional anchor portions  404   a ,  406   a , ascending therefrom to define an “H” shape. The implant  400 , as depicted, is preferably formed such that support portion  402  has a width “F” of approximately 7 cm and a height “G” of approximately 5 cm. Anchor portions  404 ,  406  preferably have a length “H” of approximately 30 cm and a width “I” of 1 cm. Additional anchor portions  404   a ,  406   a  will have a width of approximately 1.5 cm and a height “J” of approximately 14 cm, and may preferably be formed as extensions of  404  and  406 , respectively. Again, such dimensions can be varied as may be deemed appropriate by one skilled in the art. 
     In the embodiment depicted, anchor portions  404 ,  406  are operative to extend through the retropubic space, from posterior to symphysis, or may extend via a trans obturator route. Anchor portions  404   a ,  406   a  are operative to pass through the rectus fascia from anterior to symphysis. 
     Per the best mode discussed above with respect to implant  300 , the surgical procedure for implanting implant  400  (See  FIG. 10 ) will preferably be conducted with the patient assuming a lithotomy position whereby a vertical perineal incision  410  will be made in the midline ML dissecting to expose the bulbar urethra in the descending pubic rami  20 ,  22  bilaterally. The bulbar spongiosis will be left intact. Thereafter, suprapubic transverse incisions  412 ,  414  of approximately 1 cm are made, 3 cm lateral to the midline on either side. A suitable introducer  420  is then passed from such incisions and tunneled superficially anterior to the pubic symphysis (not retropubically) and caused to exit through the initial perineal incision  410 . A respective one of the ascending anchor portions  404   a  or  406   a  is attached to a suprapubic introducer  420  and pulled through the suprapubic incisions  412 ,  414 . This same maneuver is then repeated for the respective other ascending anchor portion  404   a  or  406   a.    
     Hereafter, two new incisions, which are preferably approximately 1 cm above the pubic symphysis are performed. The suitable introducer is then passed from above, retropubically, and out through the initial perineal incision. A respective one of the descending anchor portions  404  or  406  is then attached to the introducer and pulled up through such newly formed incision. Such procedure is repeated with respect to the other descending anchor portion  404  or  406 , which as a consequence creates two sets of anchor portions, namely, descending anchor portions  404 ,  406  and ascending portions  404   a ,  406   a  in the suprapubic region. The ascending anchor portions  404   a ,  406   a  are then tunneled into the retropubic anchor portions  404 ,  406  beneath the skin and thereafter ascending portion  404   a  will be surgically connected with descending portion  404  and ascending portion  406   a  surgically attached to descending anchor portion  406 . To achieve such surgical attachment, it is contemplated that such attachment may be attained via the use of sutures. 
     In a further refinement of such procedure, it is contemplated that surgical positioning of descending anchor portions  404 ,  406  can be accomplished via the use of a suitable introducer  430  that is passed from outside in (through a third incision  432  or a fourth incision  434  on the opposing side of the pelvis) or inside out (through the initial perineal incision  410 ) through the obturator foramen  18 . A suture that is attached to the distal most end of respective one of anchor portions  404 ,  406  will be threaded to the introducer. Once the introducer  430  is advanced through the obturator foramen  18 , the same is retracted with the suture affixed to the end of descending anchor portion  404  or  406  is pulled until the end of the anchor portion  404  or  406  can be grasped. A second suitable introducer is utilized with respect to the surgical positioning of the respective other anchor portion  404  or  406  on the contra-lateral side. Once so positioned, anchor portions  404  and  406  can be affixed to ascending anchor portions  404   a ,  406   a  around the descending rami via the transobturator approach and secured on itself via a suture line. 
     Referring now to  FIG. 5 , there is shown a further embodiment of an implant  500  falling within the scope of the present invention. As depicted, the implant includes a support portion  502  and first and second support portions  504 ,  506  depending therefrom in generally parallel relation to define an inverted U-shape. The support portion  502  further includes first and second apertures  508 ,  510  formed thereon through which dedicated sutures  512 ,  514  extend therethrough. The implant  500  is preferably fashioned such that the support portion  502  has a length “K” of approximately 8 cm and a height “L” of approximately 4 cm. Each respective anchor portion  504  will preferably have a length “M” of approximately 45 cm in length and a width “N” of approximately 1 cm in length. Again, the dimensions of such implant can vary as will be understood by those skilled in the art. 
     With respect to the implantation of the implant  500 , the same is again performed with the patient assuming lithotomy position. A vertical perineal incision is made in the midline dissecting to expose the bulbar urethra and the descending rami bilaterally leaving the bulbar spongiosis intact. One centimeter suprapubic transverse incisions are made 3 cm laterally to the midline on either side. A suitable introducer is then passed from this “stab wound” and tunneled superficially anterior to the pubic symphysis (not retropubically) that exits through the initial perineal incision. A respective one of the sutures  512  or  514  is attached to the introducer and pulled through the upper “stab” incision. This same procedure is repeated on the respective other side with respective other suture  512  or  514 . Respective ones of the sutures  512 ,  514  are tied down to the rectus fascia in the suprapubic area. 
     A suitable introducer is then passed from outside in or inside out through the obturator foramen. A suture that is attached to a respective one of the anchor portions  504  or  506  on one side is threaded through such introducer. The introducer is retracted and the suture is pulled until the respective one of the ends of either  504 ,  506  (depending on which portion is attached) can be grasped. The same procedure is repeated with respect to the other anchor portion  504  or  506  whereby a second introducer is passed from outside in or inside out on the contra-lateral side. Both free ends of anchor portions  504  or  506  will be overlapped and secured. Along these lines, such anchor portions  504 ,  506  will be tied around the descending rami via a trans obturator approach and thus secured to itself via a suture. 
     In a variation of the embodiment and procedure discussed above with respect to implant  500 , it is contemplated that as opposed to the use of apertures  508 ,  510  with dedicated suture lines  512  and  514  affixed thereto, the implant  500  may utilize thumb tack-like anchors (not shown) in the positions of  508  and  510 , respectively. Such embodiment will further preferably include a support portion  502  that has a width “K” of 7 cm as opposed to 8 cm. 
     To implant such embodiment, the patient will assume a lithotomy position and a vertical perineal incision will be made in the midline dissecting to expose the bulbar urethra and descending rami bilaterally leaving the bulbar spongiosis intact. The support portion  502  will be attached via these thumb tacks positioned where apertures  508  and  510  are depicted, respectively, on each side of the upper aspect of the descending rami close to the pubic symphysis. 
     A suitable introducer is then passed from outside in or inside out through the obturator foramen. A suture that is attached to a respective distal-most end of one of the anchor portions  504  or  506  is threaded through the introducer. The introducer is then retracted and the suture is pulled until the distal-most end of a respective one of one of the anchor portions  504  or  506  can be grasped. This portion of a respective one of the anchor portions is wrapped around the ramus and tied down to the support portion. A second introducer is passed from outside in or inside out on the contra-lateral side and the process is repeated with respect to the respective other anchor portion  504  or  506 . The support portion  502  is then tacked down at the upper aspect of the descending rami. The anchor portions  504 ,  506  are then tied around the descending rami via the trans obturator approach and then secured on itself via suture attachment. 
     Referring now to  FIG. 6 , a further implant  600  is depicted. As illustrated, the implant  600  comprises a generally rectangular implant defining a middle support portion  602  with anchor portions  604 ,  606  formed integral therewith and defining first and second opposed ends. According to such implant, the same will preferably be formed to have a length “O” of approximately 45 cm and a width “P” of approximately 3 cm. 
     To implant such embodiment  600 , a vertical perineal incision is made in the midline dissecting to expose the bulbar urethra and the inferior aspect of the descending rami bilaterally while the patient assumes a lithotomy position. A suitable introducer is passed from outside in or inside out through a 3 cm groin incision that is chosen with the finger in the initial perineal incision to pass through the obturator foramen. A respective end  604  or  606  that is attached to the introducer tip and advanced within the perineal incision. The introducer is retracted through the obturator foramen with the respective other end  604  or  606  being grasped at the lateral groin incision site and cut at skin level. The opposite end  604  or  606  is carried over the bulbar urethral complex. A second suitable introducer is passed from outside in or inside out through another 3 cm groin incision on the contra-lateral side and the process is repeated. The respective ends  604  and  606  of the implant  600  are cut at the level of the skin at the groin incisions. 
     The implant in embodiment  700  depicted in  FIG. 7  assumes a generally rectangular configuration having a width “Q” of 4 cm and a height “R” of 3 cm. Per the other embodiments, the implant is preferably secured into position by making a vertical perineal incision to the midline dissecting to expose the bulbar urethra and the inferior aspect of the descending rami bilaterally while the patient assumes a lithotomy position. A suture secured on a UR-6 needle is then used to bite into the periosteum of the descending rami bilaterally. Although not shown, there will be four sutures altogether on each side for a total of 8 secured knots to fix the implant  700  into position. The lower three sutures on one side are threaded through the implant, which is placed as high as possible on the bulbar urethral complex. Such lower three sutures are loosely held to stabilize the sling and the top apical suture is then placed, one on each side at the junction of the descending rami to the pubic symphysis. The apical sutures are tied down as tight as possible. The three lower sutures are then tied down accordingly on each side. 
     In the further embodiment depicted in  FIG. 8 , the implant  800  assumes a generally trapezoidal having an upper length “S” of approximately 4 cm, a lower length “T” of approximately 6 cm and a height “U” of approximately 3 cm. Such implant is secured in position via the initial formation of a vertical perineal incision that is made in the midline dissecting to expose the bulbar urethra and the descending rami bilaterally leaving the bulbar spongiosis intact. The implant  800 , which will further preferably have access holes  804  formed thereon, is then placed over the bulbar urethra complex. A fine drill, such as many of a variety well-known to those skilled in the art, is then advanced through each of the holes  804  to secure a preloaded suture. The four sutures that will extend through dedicated ones of the apertures  804  are tied along side of the lateral aspects of the implant  802  to create two knots on each side. The support portion  802  will then be operative to provide the necessary degree of suburethral support. 
     In  FIG. 9 , there is depicted yet a further embodiment of an implant  900  useful in the surgical treatment of male urinary incontinence and falling within the scope of the present invention. Such implant will preferably have the dimensions of a height “V” of 3 cm and a width of 4 cm, as the same pertains to the urethral support portion  902 . Each anchor portion  904 ,  906  will preferably have a length “X” of approximately 20 cm and a width “Y” of 1 cm. Similar to the embodiment depicted in  FIG. 3 , such embodiment  900  includes a urethral support portion  902  with two anchor portions  904 ,  906  extending therefrom in opposed directions. With regard to the best mode by which Applicants would suggest securing such implant  900  into position, such surgical procedure would involve the patient assuming a lithotomy position and, per the other embodiments discussed above, a vertical perineal incision would be made in the midline dissecting to expose the bulbar urethral and the inferior aspect of the descending rami bilaterally. A suitable introducer would then be passed from inside out or outside in through the upper aspect of the obturator foramen. An end portion of a respective one of the anchor portions  904  or  906  is attached through the introducer. The introducer is retracted and the respective other end of the respective other anchor portion  904  or  906  is grasped and a ratchet closure is done, as will be understood by those skilled in the art. Support portion  902  is carried over the bulbar urethral complex. Thereafter, a second suitable introducer is passed from inside out or outside in on the contra-lateral side and the process repeated with respect to the other respective anchor portion  904 ,  906 . The ends of the sling are then secured to a square-like portions of the urethral support portion  902  at the edge of the pubic ramus with a ratchet closure. 
     Additional modifications and improvements of the present invention may also be apparent to those of ordinary skill in the art. Thus, the particular combination of parts and steps described and illustrated herein is intended to represent only certain embodiments of the present invention, and is not intended to serve as limitations of alternative devices and methods within the spirit and scope of the invention. Along these lines, the suggested surgical implantation techniques with respect to each of the depicted embodiments simply represents the Applicants&#39; best mode for practicing the invention. It should be understood, however, that different surgical approaches may be readily known and understood by those skilled in the art. In addition, it is contemplated that future advances in medicine can and will be made that will facilitate the ability of the implants of the present invention to be more easily, quickly and accurately secured into position and operative to achieve the highest degree of favorable patient outcome. In addition, it is emphasized again that although dimensions are provided herein with respect to the implants of the present invention, as well as the choice of materials that may be utilized as to fabricate the same, it should be understood that any suitable material useful for fabricating an implant, whether known now or later developed, should be deemed to fall within the scope of the present invention.