Urodynamic analysis of the bulbourethral sling procedure

Purpose: The bulbourethral sling procedure is successful in correcting inco ntinence 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 . Materials and Methods: Between October 1994 and October 1997, 66 men underw ent the bulbourethral sling procedure at our hospital. All but 1 patient un derwent preoperative video urodynamic testing. Intraoperative urethral pres sure profilometry and abdominal leak point pressure measurements were perfo rmed. Additionally, all patients were invited to undergo followup video uro dynamic testing. Results were correlated with current continence status. Results: Preoperatively all patients demonstrated intrinsic sphincter defic iency. 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. Postoper ative voiding pressures were consistently less than corresponding Valsalva leak point pressures. Conclusions: Patients undergoing video urodynamic testing following the bul bourethral sling procedure demonstrated unobstructed voiding patterns, desp ite significant increases in Valsalva leak point pressures.