Abstract
Post-prostatectomy urinary incontinence is an uncommon complication of adenomectomies, occurring in approximately 1% of cases and being more frequent following radical prostatectomies. There is a significant implication in the quality of life for these patients. The surgical techniques employed for its treatment are the implantation of an artificial sphincter, peri-urethral injections and suburethral slings. Considering the low efficacy of peri-urethral injections and the high cost of artificial sphincters, we present in this work a technical modification of the suburethral sling, whose preliminary results are satisfactory. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra. In addition to such aspects the autologous aponeurosis does not have a cost except for a short prolongation of the surgical act.
Highlights
Post-prostatectomy urinary incontinence (PPUI) is an uncommon complication of adenomectomies, whether they are performed by transurethral or transvesical route
The actual incidence of PPUI is hard to assess, since the definition used for diagnosing incontinence varies substantially between authors and expressions such as “socially continent”, “minimal urinary leaks” contribute to make the objective interpretation of results expressed in the literature even more complicate
An analysis of PPUI indexes based on data from the North-American public health system (Medicare), revealed that 50% of patients presented some degree of urinary incontinence
Summary
Post-prostatectomy urinary incontinence (PPUI) is an uncommon complication of adenomectomies, whether they are performed by transurethral or transvesical route. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra.
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