1224 MANAGEMENT OF INTRACTABLE BLADDER NECK CONTRACTURE AND URINARY INCONTINENCE: LONG TERM EVALUATION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101224 MANAGEMENT OF INTRACTABLE BLADDER NECK CONTRACTURE AND URINARY INCONTINENCE: LONG TERM EVALUATION Polina Reyblat, Priyanka Kadam, David A. Ginsberg, and Stuart D. Boyd Polina ReyblatPolina Reyblat More articles by this author , Priyanka KadamPriyanka Kadam More articles by this author , David A. GinsbergDavid A. Ginsberg More articles by this author , and Stuart D. BoydStuart D. Boyd More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence combined with intractable posterior urethra/ bladder neck contractures after radical prostatectomy or following radiation therapy for prostate cancer presents a very difficult management problem. Urinary incontinence is routinely managed with Artificial Urinary Sphincter (AUS), however, instrumentation required to perform multiple incisions, resections and/or dilations for treatment of recurrent bladder neck contracture is a contraindication for AUS placement. Placement of an Urolume stent across the posterior urethra/ bladder neck allows it to stay open while AUS provides continence. METHODS We retrospectively evaluated medical records of 16 men who underwent Urolume stent placement with subsequent implantation of the AUS between 2004 and 2009 (follow up ranging 5 to 61 months, mean 20.4 mo) RESULTS 16 men with a mean age of 76 (range 67-88) underwent combined Urolume stent placement with AUS implantation. Etiology of bladder neck contracture and incontinence was radiation therapy alone for prostate cancer in 6, radical prostatectomy alone in 5, radical prostatectomy with radiation therapy in 3, proton beam therapy in one, and radical cystoprostatectomy with orthotopic neobladder in one. Time from initial treatment to AUS/Urolume ranged from 5 months to 27 years. Number of prior incisions/dilations ranged from 3 to 18. Two patients required subsequent addition of a second Urolume stent for further stricture management. Out of 16 patients, 9 (56%) are completely dry, 6 (37%) report minimal leak upon exertion and use 1 pad a day. The AUS mechanism is turned off in one patient secondary to the development of dementia. Four patients require periodic CIC to maintain patency of the stent. Three patients required AUS revision. Four patients developed tissue growth into the Urolume stent requiring transurethral intervention. Of the 16 patients, 14 (88%) are satisfied with the results. These patients are older, more debilitated, or have longer strictures (>2.5cm) than patients receiving urethral reconstruction. CONCLUSIONS Combination of Urolume stent and artificial urinary sphincter can be effective in management of complicated bladder neck contractures with urinary incontinence in patients suffering consequences of prostate cancer treatment. This can be accomplished with minimal morbidity and significantly less invasiveness than the alternative of urinary diversion. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e474 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Polina Reyblat More articles by this author Priyanka Kadam More articles by this author David A. Ginsberg More articles by this author Stuart D. Boyd More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...