V331 URETHRAL RECONSTRUCTION OF COMPLICATED INTRACTABLE POSTERIOR URETHRAL STRICTURES

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V331 URETHRAL RECONSTRUCTION OF COMPLICATED INTRACTABLE POSTERIOR URETHRAL STRICTURES Polina Reyblat, Manuel S. Eisenberg, Ricardo Brandina, David A. Ginsberg, and Stuart D. Boyd Polina ReyblatPolina Reyblat Sherman Oaks, CA More articles by this author , Manuel S. EisenbergManuel S. Eisenberg Los Angeles, CA More articles by this author , Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , David A. GinsbergDavid A. Ginsberg Los Angeles, CA More articles by this author , and Stuart D. BoydStuart D. Boyd Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.396AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An innovative reconstructive technique was introduced in 1984 to address intractable posterior urethral/bladder neck strictures that can potentially develop following difficult prostate cancer treatment strategies such as salvage radical prostatectomy, radical prostatectomy followed by adjuvant radiation therapy, radiation therapy with follow up transurethral resection of obstructive prostate or marked distraction of the bladder from the urethra following radical prostatectomy. The reconstruction plan employs a safe and relatively simple urethral pull-through procedure to correct the stricture with subsequent placement of an artificial urinary sphincter (Americal Medical System, Minnetonka, MN) to resolve the associated incontinence. All patients in this study had developed refractory bladder neck contractures and after repeated incisions and dilations, had dense posterior urethral strictures involving the external sphincter. The reconstruction solution with a unique urethral pull-through procedure performed perineally and placement of artificial urinary sphincter (AUS), solved both the stricturing and the incontinence. METHODS The procedure is performed totally perineally. The urethra is mobilized from the penoscrotal junction to the point of the obstruction in the urogenital diaphragm and transected. This type of mobilization makes 3-4cm of elastic urethra available for reconstruction. The stricture zone is typically 1.5-2.5cm in length, and it is incised and dilated to a 14 Hegar up into the bladder. Ideally a suprapubic catheter has been previously placed or can be placed at this time. The urethra is fixed with chromic suture to 20F Red Robinson catheter that has been pulled through the bladder suprapubically into the perineum. The urethra is then advanced up to just inside the opened bladder neck and the catheter is fixed to the abdominal wall. An AUS cuff is placed as a space holder. The urethra is well vascularized and is allowed to heal in place secondarily. The pull-through catheter is removed in 3-4 weeks. An AUS is placed 6 weeks after the initial surgery and activated 12 weeks after initial reconstruction. RESULTS The long-term results in 56 patients have been uniformly excellent. No patient has had to be diverted. Refractory stricturing of the pull-through urethra tends to be minimal (9%) and solvable. Many of these patients had previously been told that they would never urinate, and now can expect to void with a good stream and good control. CONCLUSIONS Definitive treatment for these seemingly irreparable patients can now be offered in a more timely manner. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e131 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Polina Reyblat Sherman Oaks, CA More articles by this author Manuel S. Eisenberg Los Angeles, CA More articles by this author Ricardo Brandina Los Angeles, CA More articles by this author David A. Ginsberg Los Angeles, CA More articles by this author Stuart D. Boyd Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...