V10-03 Mode of Action of the Retro-Urethral Transobturator Bulbar-Support Sling

You have accessJournal of UrologyLower Tract Reconstruction (Including Transgender) I (V10)1 May 2024V10-03 MODE OF ACTION OF THE RETRO-URETHRAL TRANSOBTURATOR BULBAR-SUPPORT SLING Peter Rehder, Patricia Kink, Gennadi Tulchiner, and Lukas Andrius Jelisejevas Peter RehderPeter Rehder , Patricia KinkPatricia Kink , Gennadi TulchinerGennadi Tulchiner , and Lukas Andrius JelisejevasLukas Andrius Jelisejevas View All Author Informationhttps://doi.org/10.1097/01.JU.0001009392.30237.90.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To demonstrate the mode of action of the retro-urethral transobturator bulbar-support sling in the treatment of male post-prostatectomy urinary incontinence. Video clips and animations demonstrate the implantation and the function of this sling. Four hypothesis in the conclusion show the functional support of the urinary sphincter mechanism, rather than causing obstruction. METHODS: The placement of the sling is demonstrated to point out critical steps of safety. The patient is in the dorsal lithotomy, with strict midline perineal incision and dissection of the proximal urethra bulb. The transobturator sling is delivered with the help of helical needle trocars placed outside in around the inferior pubic rami, with the handles held at 45 degrees. Tensioning of the ends of the sling causes indentation of the urethral bulb below the level of the membranous urethra. Endoscopic video clips are correlated with the midperineal digital support test with the patient in the lithotomy position (to check sphincter reactivity and function visualized as concentric occlusion), as well as intraoperatively before and after sling placement. This is in contrast to direct urethral pressure causing fish mouth-like flattening of the urethral lumen. RESULTS: Sling placement is distal, below and parallel to membranous urethra minimizing post-operative retention. The healthy proximal urethral bulb is indented in this position, without any direct pressure onto the urethral lumen. Graphic animation on top of a micturating cystourethrogram image of a patient during the midperineal support test demonstrates the sphincter reaction to this support. This is hypothesized to be different to the bulbocavernosus reflex, and intrinsic to normal urinary sphincter function. CONCLUSIONS: The retro-urethral transobturator bulbar-support sling (RUTOBS) in the treatment of male urinary incontinence: 1. The male urinary sphincter reacts to midperineal posterior support by increased occlusion of the sphincteric urethral lumen. 2. The RUTOBS indents the intact posterior urethral bulb of the corpus spongiosus 1cm caudal of the membranous urethra. 3. The urinary sphincter mechanism is supported distally from below the pelvic floor. 4. The RUTOBS causes no clinically relevant functional outflow obstruction to micturition. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e826 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Peter Rehder More articles by this author Patricia Kink More articles by this author Gennadi Tulchiner More articles by this author Lukas Andrius Jelisejevas More articles by this author Expand All Advertisement PDF downloadLoading ...