Urology · 2008
Mid-term outcome after bulbourethral composite suspension for postprostatectomy incontinence.
СтатьяНазвание и аннотация: Перевод в очереди
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John Hubert, Blick Nadja
Аннотация
OBJECTIVES: To report mid-term outcomes of bulbourethral composite suspension for postprostatectomy incontinence, which we have used for more than 6 years.
METHODS: A total of 57 men with a median (range) age of 67 (42 to 83) years underwent bulbourethral composite suspension with suprapubic and perineal incision, placement of a porcine dermis for urethral protection, and insertion of a polypropylene retropubic sling, which was tied suprapubically under urodynamic Valsalva leak point pressure measurement. Urinary stress incontinence was assessed preoperatively by clinical examination, urodynamic evaluation, urethrocystoscopy, and quality-of-life evaluation. Follow-up included a clinical examination, urodynamic evaluation, and quality-of-life evaluation.
RESULTS: At a median (range) follow-up of 36 (3 to 74) months, 74% of patients reported having benefit from the operation, with significantly improved quality of life. Sixty percent of the patients (34 of 57) were totally continent, 14% (8 of 57) showed a significant improvement, and 26% (15 of 57) had no benefit. Intraoperative complications occurred in 21% (12 of 57) and consisted of bladder perforations, which healed spontaneously. No obstructive voiding symptoms due to de novo bladder outlet obstruction were observed.
CONCLUSIONS: Bulbourethral composite suspension for postprostatectomy incontinence is an effective and safe method with high patient satisfaction. Mid-term follow-up at 3 years showed stable urinary continence and absence of detrusor decompensation. Bulbourethral composite suspension may become an alternative to the artificial sphincter for treatment of moderate and severe postprostatectomy incontinence.
METHODS: A total of 57 men with a median (range) age of 67 (42 to 83) years underwent bulbourethral composite suspension with suprapubic and perineal incision, placement of a porcine dermis for urethral protection, and insertion of a polypropylene retropubic sling, which was tied suprapubically under urodynamic Valsalva leak point pressure measurement. Urinary stress incontinence was assessed preoperatively by clinical examination, urodynamic evaluation, urethrocystoscopy, and quality-of-life evaluation. Follow-up included a clinical examination, urodynamic evaluation, and quality-of-life evaluation.
RESULTS: At a median (range) follow-up of 36 (3 to 74) months, 74% of patients reported having benefit from the operation, with significantly improved quality of life. Sixty percent of the patients (34 of 57) were totally continent, 14% (8 of 57) showed a significant improvement, and 26% (15 of 57) had no benefit. Intraoperative complications occurred in 21% (12 of 57) and consisted of bladder perforations, which healed spontaneously. No obstructive voiding symptoms due to de novo bladder outlet obstruction were observed.
CONCLUSIONS: Bulbourethral composite suspension for postprostatectomy incontinence is an effective and safe method with high patient satisfaction. Mid-term follow-up at 3 years showed stable urinary continence and absence of detrusor decompensation. Bulbourethral composite suspension may become an alternative to the artificial sphincter for treatment of moderate and severe postprostatectomy incontinence.