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Keywords:

  • vesico-urethral anastomosis;
  • artificial;
  • bladder neck contracture;
  • urinary incontinence;
  • radical prostatectomy;
  • urinary sphincter;
  • stricture

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

Many different approaches have been used to treat bladder neck strictures and urinary incontinence after radical prostatectomy in the past. Most techniques are highly invasive and carry a high risk of complications.

The present study describes the use of the Solovov–Badenoch ‘pull-through urethroplasty’ as well as artificial urinary sphincter implantation.

OBJECTIVE

  • • 
    To report our experience in the management of patients with combined urinary incontinence and stricture after radical prostatectomy with a two-step approach: urethroplasty with a ‘pull-through’ technique after the Solovov–Badenoch principle; and artificial urinary sphincter (AUS) insertion after 8–10 months.

PATIENTS AND METHODS

  • • 
    We retrospectively evaluated a cohort of 11 patients treated between September 2001 and January 2010.

RESULTS

  • • 
    There were no intraoperative complications in either procedure.
  • • 
    After urethroplasty one patient was unable to empty the bladder with complete urine retention without urethral stricture (treatment failure).
  • • 
    At 6 months after the urethroplasty 10 patients were completely incontinent and received AUS.
  • • 
    One previously irradiated patient developed urethral erosion 6 months after AUS implantation and underwent complete removal of the device.
  • • 
    After a mean (range) follow-up of 65 (19–119) months, nine patients (81.8%) were continent with no post-void residual urine and a perfectly functioning AUS.

CONCLUSION

  • • 
    Our experience with a two-step approach (combined suprapubic/transperineal redo anastomosis and AUS placement) shows that redo vesico-urethral anastomosis is easier than pure transperineal approaches with good results in restoring patency and that the transperineal step provides a dedicated operative field for AUS implantation with reduced risks of perioperative complications.