Elsevier

Urology

Volume 79, Issue 3, March 2012, Pages 702-707
Urology

Reconstructive Urology
Pre- and Postoperative Urodynamic Findings in Patients After a Bulbourethral Composite Suspension with Intraoperative Urodynamically Controlled Sling Tension Adjustment for Postprostatectomy Incontinence

https://doi.org/10.1016/j.urology.2011.11.012Get rights and content

Objectives

To compare pre- and postoperative urodynamic findings in patients with a bulbourethral composite suspension and intraoperative urodynamically controlled sling tension adjustment.

Methods and Patients

All data were prospectively collected from 10 patients (mean age 66 years) who successfully underwent bulbourethral composite suspension for moderate to severe postprostatectomy incontinence. Patients were evaluated preoperatively and 3–6 months postoperatively by urodynamic measurements, including urethra pressure profiles (UPPs) and pressure flow studies (PFSs). Clinical outcome was evaluated by patient-reported pad use and questionnaires (ICIQ-UI SF and I-QOL). Intraoperatively sling tension was adjusted under repeated urodynamic measurements of abdominal leak point pressure. Data were evaluated using the Kruskal–Wallis Wilcoxon test.

Results

Sling implantation was successful in all patients. Pre- to postoperative pad use decreased significantly (P < .005). Five patients were pad-free, 3 used 1 pad, and 2 used 2 pads per day. Continence and quality of life improved significantly (ICIQ-UI SF: pre-op 17 vs post-op 4.9; I-QOL: pre-op 66 vs post-op 91; P < .05 for both). Urodynamic parameters during the filling phase remained unchanged. UPPs revealed a significant increase of the maximal urethral closure pressure (pre-op 40 cm H2O vs post-op 58 cm H2O) and functional length (pre-op 31 mm vs post-op 40 mm; P < .05 for both). Postoperatively, urodynamic maximal flow rates were slightly reduced from 16 mL/s to 12 mL/s (P = .4). PFSs revealed an unobstructed voiding in all patients.

Conclusions

According to the present evaluation, a bulbourethral composite suspension with intraoperative urodynamically controlled sling tension adjustment improves continence without causing prolonged clinically or urodynamically significant voiding obstruction.

Section snippets

Patients and Pre- and Postoperative Evaluation

Ten patients with moderate (2-3 pads/day [n = 4]) or severe (>3 pads/day [n = 6]) PPSUI (conventional open n = 8, laparoscopic n = 2) were included in this study. Mean age was 66 years (range 61-71). All patients were informed about different surgical techniques and freely opted for a bulbourethral composite suspension instead of an AUS. Surgery and urodynamics were performed between 2010 and 2011. In all patients, a conservative treatment for at least 1 year after radical prostatectomy had

Results

Preoperatively, all patients had a stable detrusor pressure and a normal maximal bladder capacity (455 ± 129 mL) during filling phase. Preoperative UPPs revealed a MUCP of 40.1 ± 8.3 cm H2O and a functional length (FL) of 31.1 ± 16.5 mm.

Intraoperatively the AOP was increased from a mean 37.9 ± 7.4 cm H2O to a mean 62.6 ± 2.0 cm H2O after sling implantation. This resulted in a significant increase of the mean MUCP from 38.2 ± 15.3 cm H2O to 62.8 ± 13.6 cm H2O and the mean FL from 30.7 ± 9.4 mm

Comment

In recent years, sling techniques have become popular for the treatment of male PPSUI.16, 17, 18 Numerous publications describe their effectiveness; however, their exact mode of action remains poorly understood. In the current literature, it is distinguished between compressive and noncompressive slings.19 In both it was until recently an open question if the price to pay for continence is urinary obstruction.

In the AdVance sling, which is considered a noncompressive sling, this question has

Conclusions

Even though slightly reduced flow rates were observed in the present study, compressive slings for the bulbourethral composite suspension did not result in a prolonged, clinically, or urodynamically significant voiding obstruction in patients with moderate to severe PPSUI. Mechanisms of action seem to be at once a moderate compression of the urethra maintained by the fixed sling tension and, by contrast, a reconstruction of the male pelvic floor. Urodynamic effects of the suspension technique

Acknowledgments

We thank Prof. Michael Haessig for his statistical support and Stephan Schwyter for creating Figure 1. The authors have no conflict of interest.

References (30)

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