Mid-term Outcome After Bulbourethral Composite Suspension for Postprostatectomy Incontinence

Abstract

To report mid-term outcomes of bulbourethral composite suspension for postprostatectomy incontinence, which we have used for more than 6 years. 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. 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. 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.