Bulbourethral Composite Suspension For Treatment Of Male-Acquired Urinary Incontinence

August 13, 2007 – 12:09 pm | posted in Urology / Nephrology

UroToday.com- A recent study by Y-M Xu, X-R Zhang and colleagues from Shanghai China evaluated the efficacy of a bulbourethral composite sling procedure for the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, and posterior urethroplasty. The study is published in the June 2007 issue of European Urology.

Over a 5 year-period, a bulbourethral composite sling was performed in 26 patients with acquired urinary incontinence. Eight (30.8%) of these patients had severe urinary incontinence and 18 (69.2%) had mild to moderate urinary incontinence. The mean pre-operative duration of incontinence was 4.2 years. The procedure is described in great detail and involves attaching a polyester patch to a TVT device that is passed perineally to the suprapubic region and then tied over the rectus fascia after repeated urethral pressure measurements reached between 80 and 90 cm H2O. The mean intraoperative maximum urethral pressure was 90.8 cm H2O compared with a mean pre-operative maximum urethral pressure of 51.4 cm H2O. A urethral catheter was left for 3-4 days. Patients were followed up at 2 and 8 weeks and then at 6 month intervals for up to 54 months, mean follow-up was 28.3 months. Continence status was assessed by patient interview with a questionnaire at eh time of follow-up or by telephone interview.

Analysis of the results showed that the primary procedure failed in 1 patient. Of the remaining 25 patients 2 had recurrent stress incontinence at 1.5 and 2 years post-operatively. The recurrent incontinence was severe in one patient and mild (1 to 2 pads) in the other patient. Of the remaining 23 patients, 19 were cured and the others were improved.

One of the most significant findings of the study was that social continence was achieved in 94% (16 of 17) of patients with mild and moderate stress urinary incontinence but only in 25% (2 of of patients with severe incontinence at 12 months of follow-up. This difference was statistically significant making careful patient selection very important for the most beneficial outcome when using this procedure.