Suprapubic wad suspension. Combined perineal-abdominal approach for correction of postprostatectomy urinary...

A three-year experience with 20 patients who became incontinent after various types of prostatectomies is described. A new method of repair using a combined approach is presented. The perineal component allows the insertion of a pliable prosthetic "wad." The posterior edge of the wad is held in a position inclined 20 degrees toward the vertical plane of the recumbent patient's perineum by two heavy nylon sutures. The sutures are brought into the previously dissected retropubic space by the use of a 10-cm. long Keith needle which is passed through the urogenital diaphragm. The ends of the sutures are tied over small marlex pledges over the abdominal fascia. There were two failures and one case in which urethral stricture developed among the 20 patients undergoing surgery.