Longitudinal urethral sling with prepubic and retropubic fixation for male urinary incontinence

OBJECTIVE: Description and early results of a new urethral sling technique for treatment of postprostatectomy urinary incontinence, which combines efficacy, low cost and technical simplicity. MATERIALS AND METHODS: From May 2003 to April 2004, 30 patients with moderate or total urinary incontinence, following radical prostatectomy or endoscopic resection of the prostate, underwent the new technique. The technique is based on the placement of a longitudinal-shaped sling in the bulbar urethra, measuring 4 cm in length by 1.8 cm in width, made of Dacron or polypropylene mesh, fixed by 4 sutures on each side, with 2 sutures passed with Stamey-Pereira needle by retropubic approach and 2 by prepubic approach, which are then tied over the pubis. Pressure control was determined by interrupting the loss of infused water through a suprapubic cystostomy 60 cm from the pubis level. RESULTS: Pre-operative assessment excluded vesical instability, urethral stenosis and urinary infection. Suprapubic cystostomy was removed when the patient was able to satisfactorily void with urinary residue lower than 100 mL, which occurred in 29 of the 30 cases. In 2 cases, there was infection of the prosthesis, requiring its removal. In 3 cases, there was the need to adjust the sling (increasing the tension), due to failure of the urinary continence. Overall, 20 of 30 (66.7 percent) operated patients became totally continent, and did not require any kind of pads. Four of 30 (13.3 percent) patients achieved partial improvement, requiring 1 to 2 pads daily and 6 of 30 (20 percent) patients had minimal or no improvement. There was no case of urethral erosion. CONCLUSION: This new sling technique has shown highly encouraging preliminary results. Its major advantage over other surgical techniques for treatment of moderate or severe stress urinary incontinence is the simplicity for its execution and low cost. A long-term assessment, addressing maintenance of continence, detrusor function and preservation of the upper urinary tract, is still needed.

Is the periprostatic anesthetic blockade advantageous in ultrasound-guided prostate biopsy?

OBJECTIVE: To assess the benefit of the periprostatic administration of lidocaine previously to ultrasound-guided prostate biopsy. MATERIALS AND METHODS: In the period from April to October 2002, forty patients underwent ultrasound-guided prostate biopsy due to increased PSA or abnormal digital rectal examination. A randomized double-blind study was performed, where the patients received an injection of lidocaine 2 percent or saline solution, in a total of 10 ml periprostatic. Immediately following the biopsy, the pain associated to the procedure was assessed, using a visual analogical scale from 0 to 10. The mean number of fragments collected per patient in the biopsies was 11.3. The statistical analysis used for assessment of pain was the Student's t, with p < 0.05 being significant. RESULTS: The groups were homogeneous concerning the anthropometrical data. In relation to pain, those patients in the groups that underwent biopsy with the use of lidocaine presented a maximum score of 6, while in the group that underwent biopsy with the use of saline solution, 4 patients presented score 7 ou 8. The mean score and standard deviation with lidocaine were 2.55 ± 2.34 (CI 95 percent = 1.53 to 3.57) and with saline solution were 3.75 ± 2.52 (CI 95 percent = 2.66 ± 4.84) with no statistical significant difference between the groups. CONCLUSION: The lidocaine injection did not show statistical difference when compared with saline solution in the periprostatic blockade during echo-guided prostate biopsy.