Intraoperative adjustible non obstructive bulbourthral suspension
Intraoperative adjustible non obstructive bulbourethral suspension
Y. Wyss1, M. Randazzo1, P. Viktorin2, B. Förster1, H. John1
1Kantonsspital Winterthur, Klinik für Urologie, Winterthur, Schweiz, 2Kantonsspital St. Gallen, St.Gallen, Schweiz
The bulbourethral suspension with intraoperative urodynamic adjustment was proposed for patients with post-radical prostatectomy incontinence in 2004. This non obstructive sling technique has now been routinely used for years in our department in patients with severe stress incontinence.
This video demonstrates the standardized technique. Antegrade urethral opening pressure and functional urethral length are determined. After a perineal vertical midline incision the bulbocavernous muscle is splitted. In a next step, an angled guide needle is introduced paraurethrally through the perineal access and is brought up strictly retropubically to the suprapubic skin. Through the needle a 2.5 cm wide partial resorbable sling is drawn suprapubic with a wire. The suspension elevates the pelvic floor and improves functional urethral coaptation. A transverse suprapubic incision is made down onto rectus fascia. Pressure of the fist is applied onto the bladder with parallel increase of the sling tension to determine optimal antegrade urethral opening pressure. We aim an increase of the antegrade urethral pressure of 20-25 H20, as well as a prolonged functional urethral length. Once the final pressure is accepted, the polypropylene ends are knotted.
In 2004, initial series showed feasability in 16 patients with social urinary continence rate of 69 %. Midterm term follow-up results after 36 months in 57 patients confirmed stable 60 % social continence and 14% significant improvement. Pressure-flow studies excluded infravesical obstruction.
The presented bulbourethral suspension technique is a standardized, intraperative adjustable and non obstructive urethral sling technique with high social continence rate and patient statisfaction.