New perineal tensive transobturator tape (T-TOT) for postprostatectomy urinary incontinence.

UNLABELLED: Bulbourethral transobturator sling data from other investigators report a success rate from 53% to 85%. Since the degree of sling tension and its adjustment seems to be important for achieving complete urinary continence we present results on the first consecutive 12 patients, with mild post prostatectomy stress urinary incontinence--defined as--less than 500 ml, who underwent a new perineal tensive transobturator polypropylene tape (T-TOT) procedure at our institution. RESULTS: Pre-operative mean abdominal leak point pressure (ALPP) was 23 cm H2O (sd +/- 10), retrograde leak point pressure (RLPP) was 24 cm H2O (sd +/- 6) and the mean pad test was 324 g (sd +/- 176). The overall success rate has been of 58.3% (7 patients) complete responders (CR), 33.3% (4 pts) partial responders (PR) and 8.33% (1 patient) failure. No significant urodynamic outlet obstruction nor urethral erosion occurred at 9-month follow up occurred. Post operative ICIQ-SF questionnaire score dropped from 11 to 3 with significant statistical evidence (p < 0.01). CONCLUSION: Perineal T-TOT showed safe and effective results similar to conventional bulbourethral transobturator male slings without obstructive symptoms despite maximal tension was used. Anyway longer prospective follow up is needed to determine the long-term efficacy of this procedure and the effective preservation from urethral erosion.

[Urethro-autoplasty: scrotal in-lay, mesh-graft, buccal on-lay]. / Uretro-autoplastiche: in-lay scrotale, mesh-graft, on-lay buccale.

The surgical therapy of the urethral strictures is still controversial as it interests the choice of an appropriate technique among many methods. In cases of complex urethral strictures, urethroplasties using genital or extragenital tissue for reconstruction are indicated. Scrotal in-lay was popular some years ago, but the complications rate was high. Nowdays, the two techniques with better outcome are the mesh graft urethroplasty and the buccal mucosa on-lay urethroplasty.