Surgical treatment of the male incontinence by bulbourethral sling using prolene tape (TBT) - long-term follow-up
Abstract
Urinary incontinence in man as a consequence of prostate surgery represents a long-term social and economic problem with impact on the mental state of man and his quality of life. Material and methods: In 32 patients with stress incontinence of degree II or III (16 after transurethral prostatectomy, 11 after radical prostatectomy, 4 after transvesicular prostatectomy, and 1 after medullar injury), we have performed bulbo-urethral sling operation using prolene tape.
A special tape made of prolene is introduced under the bulbar urethra by the transperineal access using a bent steel needle. The entry for the needle is located laterally to the bulbar urethra and m. bulbospongiosus, it crosses the urogenital diaphragm (m. transversus perinei profundus) into the retropubic space and along the posterior side of symphysis to the abdominal wall.
Panendoscopic and urodynamic examination was performed before the operation, urodynamic examination and ascending and micturition urethrocystography followed 6 months after the operation. The mean period of follow-up was 23 months (2-48).
Results: Sixteen patients after TBT are fully continent, 11 patients have stress incontinence of degree I and 5 patients have remained with stress incontinence of degree III. We have recorded 4 cases of serious complications; 9 patients had irritation micturition problems 8 weeks after the operation.
The mean duration of the operation was 51 minutes, the mean hospitalization period was 4.3 days. Conclusion: Bulbo-urethral sling operation using prolene tape represents a novel, effective solution for urinary incontinence in man.
Decisive for the correct indication of the patients for this intervention is pre-operative urodynamic examination