Urodynamic analysis of the bulbourethral sling procedure

The bulbourethral sling procedure is successful in correcting incontinence following radical prostatectomy. However, the mechanism of action of the sling is not intuitively clear. We analyze the results of urodynamic testing on a cohort of men who underwent the bulbourethral sling procedure.

Between October 1994 and October 1997, 66 men underwent the bulbourethral sling procedure at our hospital. All but 1 patient underwent preoperative video urodynamic testing. Intraoperative urethral pressure profilometry and abdominal leak point pressure measurements were performed. Additionally, all patients were invited to undergo followup video urodynamic testing. Results were correlated with current continence status.

Preoperatively all patients demonstrated intrinsic sphincter deficiency. Following sling placement postoperative Valsalva leak point pressure values were significantly increased but maximum resting urethral pressures were unchanged. Preoperative and postoperative Abrams-Griffiths nomograms were not consistent with postoperative bladder outlet obstruction. Postoperative voiding pressures were consistently less than corresponding Valsalva leak point pressures.

Patients undergoing video urodynamic testing following the bulbourethral sling procedure demonstrated unobstructed voiding patterns, despite significant increases in Valsalva leak point pressures.