title: Pre- and postoperative urodynamic findings in patients after a bulbourethral composite suspension with intraoperative urodynamically controlled sling tension adjustment for postprostatectomy incontinence.
abstract: OBJECTIVE
  To compare pre- and postoperative urodynamic findings in patients with a bulbourethral composite suspension and intraoperative urodynamically controlled sling tension adjustment.
  
  
  METHODS
  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 H(2)O vs post-op 58 cm H(2)O) 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.
authors.affiliation: Department of Urology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, Switzerland. marcushorstmann@gmx.ch
authors.forename: Marcus
authors.initials: M
authors.lastname: Horstmann
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fischer
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmer
authors.forename: Kevin
authors.initials: K
authors.lastname: Horton
authors.forename: Michael
authors.initials: M
authors.lastname: Kurz
authors.forename: Christian
authors.initials: C
authors.lastname: Padevit
authors.forename: Hubert
authors.initials: H
authors.lastname: John
mesh_terms: D000368:Aged; D006801:Humans; D016496:Incontinence Pads / Q000706:statistics & numerical data; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011788:Quality of Life; D053825:Suburethral Slings; D014521:Urethra / Q000503:physiopathology; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods*