Bulbourethral composite suspension for treatment of male-acquired urinary incontinence.
OBJECTIVE
We evaluated the efficacy of bulbourethral composite sling procedure in the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, or prostatic enucleation for benign prostatic hyperplasia, and posterior urethroplasty.


METHODS
Between May 2000 and April 2005, 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. A polyester patch plus tension-free vaginal tape (TVT) device was used in the procedure. Prolene threads were attached to the two ends of polyester taper then passed from the perineal incision to a suprapubic incision with a TVT needle. The ends of the sutures and TVT were tied over the rectus fascia in the midline after repeated urethral pressure measurements reached 80-90 cm H2O.


RESULTS
The follow-up period was 8-54 mo (mean: 28.3). The primary procedure failed in one patient. Of the remaining 25 patients, 1 patient died of cerebral hemorrhage 2 yr postoperatively, and 2 patients had recurrent stress incontinence in 1.5 and 2 yr postsurgery, respectively. The recurrent incontinence was severe in one patient and mild (one to two pads per day) in the other. The remaining 22 patients maintained urination and continence. The total success rate (cure and improved) was 92% (23 of 25).


CONCLUSIONS
Bulbourethral composite sling procedure is a minimally invasive, safe, effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Temporary perineal discomfort or pain is a common complication of the procedure.
Xu
Yue-Min
YM
Department of Urology, Jiaotong University Affiliated Sixth People's Hospital of Shanghai, Shanghai, People's Republic of China. xuyuemin@263.net
Zhang
Xin-Ru
XR
Sa
Ying-Long
YL
Chen
Rong
R
Fei
Xiao-Fang
XF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011312:Pressure; D011468:Prostatectomy / Q000009:adverse effects; D011470:Prostatic Hyperplasia / Q000601:surgery; D053825:Suburethral Slings; D013536:Suture Techniques; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*