PD14-03 OPEN SURGICAL RECONSTRUCTION FOR RECALCITRANT BLADDER NECK CONTRACTURES – FUNCTIONAL OUTCOME AFTER IMPLANTATION OF AN ARTIFICIAL URINARY SPHINCTER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) II1 Apr 2015PD14-03 OPEN SURGICAL RECONSTRUCTION FOR RECALCITRANT BLADDER NECK CONTRACTURES – FUNCTIONAL OUTCOME AFTER IMPLANTATION OF AN ARTIFICIAL URINARY SPHINCTER Simon Bugeja, Anastasia Frost, Enrique Fes, Stella Ivaz, Daniela E. Andrich, and Anthony R. Mundy Simon BugejaSimon Bugeja More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Enrique FesEnrique Fes More articles by this author , Stella IvazStella Ivaz More articles by this author , Daniela E. AndrichDaniela E. Andrich More articles by this author , and Anthony R. MundyAnthony R. Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1332AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open surgical reconstruction is the only curative treatment for bladder neck contractures (BNC) and prostatic urethral stenoses resulting from the treatment of prostate cancer which are refractory to endoscopic intervention. This invariably results in incontinence requiring a second intervention to restore continence. We review the functional outcome after open reconstructive surgery and subsequent artificial urinary sphincter (AUS) implantation. METHODS Between 2006 and 2012, 32 patients (mean age 65.5 years) were treated in a single unit. Men with anastomotic contractures following radical prostatectomy (RP) (n=16) or RP and adjuvant radiotherapy (n=6) underwent transperineal revision of the vesico-urethral anastomosis (VUA). Those with prostatic stenoses following external beam radiotherapy, HIFU, cryotherapy, brachytherapy or a combination of these (n=10) were treated by salvage RP via an abdomino-perineal approach. All had failed multiple previous attempts at endoscopic management. A bulbar AUS was subsequently implanted on average 9.1 months after the reconstruction. RESULTS The overall stricture-free rate after reconstruction was 87.5% (28 of 32). Two patients developed recurrent strictures following transperineal redo-VUA. All the rest, except one who declined, went on to have a bulbar AUS implanted (n=19). All are dry at a mean follow-up of 31.2 months except one unirradiated patient with recurring incontinence due to device malfunction. 8 of 10 patients (80%) having salvage RP were successful. 7 underwent AUS implantation. 4 remain dry after their primary implant, 3 are dry however had their devices revised for erosion (1) and malfunction (2). Therefore functional normality (unobstructed and continent) was achieved in 18 of 22 (81.8%) transperineal reconstructions. In irradiated patients with prostatic stenoses, 7 of 10 (70%) were rendered functionally normal after salvage RP albeit with a higher rate of AUS revision as a consequence of the primary irradiation treatment. CONCLUSIONS Surgical correction of recalcitrant BNC after treatment of prostate cancer is feasible and very effective in experienced hands however requires implantation of an AUS to restore functional normality. Patients must be councelled appropriately especially if previously continent. Salvage RP, though technically challenging, with longer hospital stays and time to catheter-free status, is the treatment of choice in radiotherapy or focal therapy-related prostatic urethral stenoses. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e319-e320 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Bugeja More articles by this author Anastasia Frost More articles by this author Enrique Fes More articles by this author Stella Ivaz More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...