[Suburethral sling for male urinary incontinence].
This article describe a new technique for treating post-prostatectomy urinary incontinence. We performed this procedure on 15 patients with a follow-up of 2 to 9 months. All of the patients had radical retropubic prostatectomies and a urodynamically confirmed stress urinary incontinence for more than one year; 3 of the 15 (20%) had detrusor instability. We used the exaggerated lithotomy position and a perineal approach. Three 5 mm titanium bone screw with pre-loaded No 1 polypropylene sutures (In fast Straight-In bone Screw Suture system) were placed on each side of the inner surface of the descending pubic ramus. To support the bulbar urethra was used a cadaveric fascia lata graft, reinforced with a piece of folded polypropylene mesh and tied to the pubic bone using the sutures attached to the bone anchors. Urethral resistance was increased to 45 cm H2O above baseline pressure. Thirteen patients (86.6%) are completely cured, i.g., do not require any pads. We have seen total failure in 1/15 patients (6.6%) and minimal improvement in 1/15 patients (6.6%). Urgency incontinence was reported in 3/15 patients (20%). All responded to the use of anticholinergic therapy. Two of the three patients with post-operative urgency incontinence had preoperative detrusor instability documented on urodynamic evaluation. This minimally invasive male sling procedure is efficacious. Long-term follow-up will be necessary before a final assessment of this new technique is rendered.
Defidio
Lorenzo
L
Divisione di Urologia, Ospedale Cristo Re, Roma. defidio@tin.it
Franco
Nick
N
Baum
Neil
N
D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects; D014521:Urethra; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male