Bulbo-prostatic Anastomotic Urethroplasty Research Articles

Management of Pelvic Fracture Urethral Injury in Pediatric Patients

Purpose: Pediatric urethral surgery represents a significant surgical challenge due to smaller pelvis, decreased caliber and increased tissue fragility. This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Methods: We performed 47 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to January 2020. Mean age was 13 years with majority between 10 to 18 years (>85%). All were male patients. Two patients had history of failed anastomotic urethroplasty. Patients were selected as per selection criteria and were prepared for operation after adequate counseling. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 91.47%. Total 4 procedures were failed including 1 urethro-cutaneous fistula and needed re-do anastomosis. We could not evaluate erectile dysfunction (ED) as many patients were unable to give appropriate information. Two patient developed incontinence which improved in subsequent follow-up. Conclusions: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Operative series of pediatric urethral reconstruction usually involve small numbers. Experiences of anastomotic urethoplasty in large volume adult series reflects the higher outcome in pediatic patients. Bangladesh J. Urol. 2021; 24(1): 77-81

Management of Pelvic Fracture Urethral Injury- 147 Cases

Background: Dhaka Medical College Hospital is the highest referral center for PFUI. As anstomotic urethroplasty is a challenging surgery and most of the surgeons refer these type of injuries to our center, we performed this study to evaluate the outcome of our cases.
 Objective: This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture.
 Materials and Methods: We performed 147 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to May, 2019. Mean age was 37 years with majority between 21 to 50 years (>85%). Nine patients had history of failed anastomotic urethroplasty. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful.
 Results: Success rate of anastomotic urethroplasty for PFUI was 93.87%. Total 9 procedures were failed including 2 urethro-cutaneous fistula and needed re-do anastomosis. Erectile dysfunction (ED) was present in 18 patients before operation and after surgery 12 more patients developed ED and total number was 30 during first follow up, which reduced to 24 during second follow-up. Two patient developed incontinence which improved in subsequent follow-up.
 Conclusion: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Erectile dysfunction is the main issue to be concerned and need special attention.
 KYAMC Journal Vol. 10, No.-4, January 2020, Page 179-183

V82 - Redo bulbo-prostatic anastomotic (BPA) urethroplasty for recurrent pelvic fracture-related urethral strictures

V82 - Redo bulbo-prostatic anastomotic (BPA) urethroplasty for recurrent pelvic fracture-related urethral strictures

V05 - Redo bulbo-prostatic anastomotic urethroplasty for recurrent pelvic fracture-related urethral strictures

V05 - Redo bulbo-prostatic anastomotic urethroplasty for recurrent pelvic fracture-related urethral strictures

PD44-06 WHAT CONSTITUTES COMPLEXITY IN THE SURGICAL RECONSTRUCTION OF PELVIC FRACTURE-RELATED URETHRAL INJURIES?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-06 WHAT CONSTITUTES COMPLEXITY IN THE SURGICAL RECONSTRUCTION OF PELVIC FRACTURE-RELATED URETHRAL INJURIES? Simon Bugeja, Stella Ivaz, Anastasia Frost, Enrique Fes, Felix Campos, Daniela Andrich, and Anthony Mundy Simon BugejaSimon Bugeja More articles by this author , Stella IvazStella Ivaz More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Enrique FesEnrique Fes More articles by this author , Felix CamposFelix Campos More articles by this author , Daniela AndrichDaniela Andrich More articles by this author , and Anthony MundyAnthony Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bulbo-prostatic anastomotic urethroplasty (BPA) for urethral injuries associated with traumatic disruption of the pelvic ring is notoriously a surgical challenge, often requiring various manouvres to straighten the course of the bulbar urethra and bridge the resulting defect. There are however other factors which may render the reconstructive procedure more complex. This study investigates these factors. METHODS 360 BPAs were performed in a single tertiary referral centre between October 1996 and October 2014. 77 (21%) were revision procedures. Mean patient age was 37.9 years. Mean follow-up was 51 months (range 9-115 months). Recurrence was defined radiologically and/or by the need for any further surgical intervention including dilatation or urethrotomy. RESULTS 286 (79%) procedures were carried out transperineally (Step 1-4) while 74 (21%) required additional abdominal exposure to mobilise the bladder bladder base (n=16), repair associated injuries (n=41) or perform an entero-urethroplasty (n=17). 29 of 74 (39%) abdomino-perineal (AP) procedures were revisions. 48 of 77 revisions (62%) were performed via a transperineal approach. The restricture rate was higher for revision procedures compared to primary ones when approached transperineally (15% vs 8%) but not for AP procedures (21% in both primary and revision cases). Overall, the recurrence rate for AP procedures was 21% compared to 9% for the transperineal approach. Associated bladder neck injury (n=18), uro-rectal/perineal fistulae (n=15), perineal degloving injury (n=6), anterior urethral stricture (n=19) and osteomyelitis/pelvic sepsis (n=10) were identified as factors adding complexity to the procedure. CONCLUSIONS A longer defect and revisional surgery often require corporal separation, inferior wedge pubectomy and rerouting of the urethra around the crura in a stepwise fashion in order to guarantee a tension-free anastomosis. These render the procedure more difficult but do not necessarily imply increasing complexity. Factors necessitating a change in approach (usually but not exclusively requiring additional abdominal exposure) to deal with multiple pathologies such as the need for bladder neck reconstruction or concominant anterior urethral strictures are what render the procedure complex. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1000 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Simon Bugeja More articles by this author Stella Ivaz More articles by this author Anastasia Frost More articles by this author Enrique Fes More articles by this author Felix Campos More articles by this author Daniela Andrich More articles by this author Anthony Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

383 FUNNELLING OF THE BLADDER NECK AFTER RADICAL RETROPUBIC PROSTATECTOMY - RADIOLOGICAL APPEARANCE AND CLINICAL RELEVANCE

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (III)1 Apr 2013383 FUNNELLING OF THE BLADDER NECK AFTER RADICAL RETROPUBIC PROSTATECTOMY - RADIOLOGICAL APPEARANCE AND CLINICAL RELEVANCE Simon Bugeja, Ishaan Chaudhury, and Daniela E. Andrich Simon BugejaSimon Bugeja London, United Kingdom More articles by this author , Ishaan ChaudhuryIshaan Chaudhury London, United Kingdom More articles by this author , and Daniela E. AndrichDaniela E. Andrich London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1771AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Characteristic anatomical changes occur following radical retropubic prostatectomy (RRP) for prostate cancer. Consequently identification of individual landmarks namely the vesico-urethral anastomosis (VUA), bladder base above and membranous urethra below may be more difficult on routine imaging. As a result, in patients with post-RRP bladder neck contractures (BNC) localising the exact site of the stricture may not be possible in many cases. It has become apparent to us that one such anatomical change responsible for this can be identified radiologically as ‘funnelling' of the bladder neck. We define MRI and urethrographic evidence to support this. METHODS 106 post-RRP pelvic MRIs were reviewed. These were T2 weighted images in the coronal plane. Surgery had been performed between 1994 and 2011 via an open or laparoscopic/robotic approach. A further 19 pre-operative ascending/descending urethrograms in patients with proven post-prostatectomy BNC who eventually went on to have open surgical correction (redo-VUA) were also reviewed. RESULTS In 81 of 106 MRIs reviewed (76.4%), the bladder base was not flat but was noted to have a tapered, ‘funnel-shaped' appearance, seen to lie within the levator sling. This is irrespective of whether an open or minimally invasive approach was adopted. Of the 19 patients having confirmed BNC, this typical funnelled appearance was noted in 16 of the 19 urethrograms (84.2%). 7 of these patients also had an MRI and in all, funnelling of the bladder neck was present. During most cases of revision surgery for BNC, significant scarring and fibrosis is present and this extends more proximally than the anastomosis itself. The dissection needs to be taken further backwards to identify a healthy ‘bladder neck', often necessitating crural separation and inferior wedge pubectomy to allow access and a tension-free anastomosis. This tends to make surgery more complicated than a routine bulbo-prostatic anastomotic urethroplasty following pelvic fracture and we believe that this ‘funnelling' is responsible. CONCLUSIONS Funnelling of the bladder neck is a clearly identifiable radiologic finding on MRI and fluoroscopy after RRP. This makes it difficult to identify anatomical landmarks and the exact location of strictures using routine imaging techniques when planning surgery for BNC. This funnelled area gets caught up in the scarring and fibrosis around the anastomosis and probably accounts for the more extensive dissection necessary to reach healthy bladder neck tissue during reconstruction in these cases. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e155 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Bugeja London, United Kingdom More articles by this author Ishaan Chaudhury London, United Kingdom More articles by this author Daniela E. Andrich London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pelvic fracture‐related injuries of the bladder neck and prostate: their nature, cause and management

To report our experience of bladder neck injuries, which are a well recognized but rare consequence of pelvic fracture-related trauma to the lower urinary tract, as we have been unable to find any reference in the English literature to their specific nature, cause and management in adults. In the last 10 years we have treated 15 men with bladder neck injuries after pelvic fracture. Two were treated at our centre by delayed primary repair. Thirteen were initially treated elsewhere and presented to us 3 months to 5 years after their injury with intractable incontinence and various other symptoms most notably recurrent urinary infection and gross haematuria. Twelve of the injuries were at or close to the anterior midline and associated with lateral compression fractures or 'open-book' injuries. Five of them were confined to the bladder neck and prostatic urethra; the other seven extended into the subprostatic urethra. Four of these were associated with a coincidental typical rupture of the posterior urethra. All had an associated cavity involving the anterior disruption of the pelvic ring. Two of the injuries, following particularly severe trauma, were a simultaneous complete transection of the bladder neck and of the bulbo-membranous urethra with a sequestered prostate between. We have seen this in children before but not in adults. Another injury, also after particularly severe trauma, was an avulsion of the anterior aspect of the prostate. We have not seen this described before. Fourteen patients underwent lower urinary tract reconstruction and one underwent a Mitrofanoff procedure. All of the 14 had a layered reconstruction of the prostate and bladder neck and in 13, this was supplemented with an omental wrap. In all patients with an anterior midline rupture, the primary injury appeared to be to the prostate and prostatic urethra with secondary involvement of the bladder neck and the subprostatic urethra. The Mitrofanoff procedure was successful. Of the 14 patients with a layered reconstruction one, without an omental wrap, broke down but was successfully repaired on a subsequent occasion. The four patients who also had a ruptured urethra had a simultaneous bulbo-prostatic anastomotic urethroplasty, two of which required further attention. Eight of the 14 reconstructed patients underwent implantation of an artificial urinary sphincter (AUS) for sphincter weakness incontinence, in seven of whom this was successful. Two of these had previously undergone implantation of an AUS with an unsatisfactory outcome and were made continent by bladder neck reconstruction. The other six patients had acceptable urinary incontinence by reconstruction of the bladder neck and urethra alone. The primary injury is to the prostate and prostatic urethra. The bladder neck and subprostatic urethra are involved secondarily by extension. These injuries have a particular cause and a particular location with a predictable outcome. They need to be identified and treated promptly as they do not heal spontaneously and otherwise cause considerable morbidity. We also describe two particular types of bladder neck injury that we have not seen described before in adults.

Use of pedicled tunica vaginalis flap in elaborated perineal approach for bulboprostatic anastomotic urethroplasty

We describe the use of a pedicled tunica vaginalis flap to cover the anastomotic area after progressive elaborated perineal bulboprostatic anastomotic urethroplasty. Urethroplasty is completed in the standard technique. The tunica is opened longitudinally and dissected away as a rectangular flap from the testis and wrapped around the urethra.

Bulboprostatic anastomotic urethroplasty with preservation of potency: Anatomical study, operative approach and clinical results

OBJECTIVE. To identify the precise anatomy of the membranous and bulbous urethrae and their relation to the neurovascular bundles (cavernous nerves and vessels). Based on the findings, a modified surgical technique was developed to preserve potency by avoiding injury to the neurovascular bundles during surgery on the posterior urethra. The material for this study consisted of 10 male cadavers. We injected eight cadavers with a mixture of red latex and lead oxide. By means of meticulous dissection we removed the bladder, prostate, urethra, penis, surrounding vessels and nerves. We also identified the anatomical relations between various urogenital structures and the vessels and nerves. We examined the specimens radiologically. In the other two cadavers, we removed the membranous urethrae and subjected them to histological examination. We used haematoxylin-eosin and Verhoeff von Gieson stains to study the elastic tissues. The membranous urethra measured 2.5-3 cm in length. It originated from the lower third of the anterior surface of the prostate (and not from the apex) as a continuation of the prostatic urethra. The wall of the membranous urethra contained abundant elastic fibres. The neurovascular bundles were located posterolateral to the mid-portion of the prostate and prostatic apex. Near the apex the neurovascular bundle divided into two parts: a larger anterior part and a smaller posterior part. The anterior part crossed the membranous urethra, then the bulb of the penis at the 1 and 11 o'clock positions and finally entered the corpus cavernosum. The posterior part crossed the membranous urethra more posteriorly to enter the bulb of the penis. Between 1992 and 2003 we managed 22 patients (age range 16-50 years) with posterior urethral obstruction secondary to pelvic fracture by means of bulboprostatic anastomosis. We managed 17 patients via the perineal route and five via a combined perineoabdominal-transpubic route. All of these patients were potent before the operation, which proved the integrity of the neurovascular bundles. We could spare the anterior divisions of the neurovascular bundles (greater cavernous nerves and vessels) during their crossing of the bulb of the penis by cutting and dissecting within the bulb (not outside it) before dismembering it from the urogenital diaphragm. We also refrained from any dissection of the apex and the posterolateral surfaces of the prostate to avoid injury to the neurovascular bundles. At 6-year follow-up (range 1-10 years) 21/22 patients preserved their potency, giving a success rate of 95.45%. Of the 22 patients, two became temporarily impotent after the operation but regained potency within a period of 4-6 months. Our technique of neurovascular bundle preservation during bulboprostatic anastomotic urethroplasty may solve the problem of postoperative impotence.

Management of urinary incontinence after bulboprostatic anastomotic urethroplasty for posterior urethral obstruction secondary to pelvic fracture.

To present our experience of the management of urinary incontinence after bulboprostatic anastomotic urethroplasty for post-traumatic posterior urethral obstruction secondary to pelvic fracture. Between 1979 and 1998, we managed 13 patients with postoperative incontinence after bulboprostatic anastomotic urethroplasty. Of these patients, nine had undergone a transpubic approach and four a perineal approach. The causes of urinary incontinence in the 13 patients were as follows. Ten patients had derangement of the proximal sphincteric mechanism (the distal sphincteric mechanism is usually destroyed as a result of trauma and/or during urethroplasty). These 10 patients were managed by placement of an anterior bladder tube, after the failure of pharmacological manipulations. Two patients who had been managed by transpubic urethroplasty experienced complications due to vesicourethral fistulae. They were managed by excision of the tract and repair of the bladder and the urethral defects. One patient, who was managed additionally by visual urethrotomy (for postoperative obstruction after perineal bulboprostatic anastomosis), experienced complications due to a false tract between the bladder and urethra. He was managed by bulboprostatic anastomosis and excision of the false tract. After 1-6 years follow-up, the outcome of the 10 patients who underwent placement of a bladder tube was good in four (40%), fair in three (30%) and poor in two (20%). The two patients who presented with vesicourethral fistulae regained continence after excision of the fistulae. The patient who had a false tract between the bladder and urethra regained continence after revision of the bulboprostatic anastomosis and excision of the fistulous tract. The proximal sphincteric mechanism should be fully evaluated before performing bulboprostatic anastomosis. Placement of a bladder tube is a good option for managing urinary incontinence. Vesicourethral fistulae are an unrecognized cause of urinary incontinence following transpubic urethroplasty. Visual urethrotomy should only be used in short, passable strictures.

Mechanism of continence after repair of post-traumatic posterior urethral strictures

Objectives To determine the mechanism of urinary continence after repair of post-traumatic posterior urethral strictures by perineal anastomotic urethroplasty. Methods Two groups of male patients were enrolled in this study. Group 1 consisted of 8 patients (mean age 31 years) who had undergone bulboprostatic anastomotic urethroplasty for strictures complicating a pelvic fracture urethral disruption. Group 2 consisted of 8 patients (mean age 32.5 years) with a normal urethra who were used as controls. All 16 patients underwent urethral pressure profilometry both at rest and with cough and hold maneuvers. Results In group I, urethral pressure profilometry showed much lower mean maximal urethral pressures and maximal urethral closure pressures, as well as a much shorter mean functional profile length than in group 2 (48 and 39 cm H 2O versus 75 and 65 cm H 2O and 2.4 versus 4 cm, respectively, P <0.0003). On cough maneuver, intra-abdominal pressure changes were transmitted along the entire functional profile length in group 1 and only along its first part in group 2. The hold maneuver increased urethral pressure in 5 patients (65%) in group 1 and in all 8 patients (100%) in group 2. Conclusions Continence after anastomotic urethroplasty for post-traumatic posterior urethral strictures is maintained solely by the proximal urethral mechanism. Transmission of intra-abdominal pressure changes and contraction of pelvic floor musculature may augment urethral closure in these cases during stress conditions.

1-STAGE DELAYED BULBOPROSTATIC ANASTOMOTIC REPAIR OF POSTERIOR URETHRAL RUPTURE: : 60 PATIENTS WITH 1-YEAR FOLLOWUP

The long-term results of delayed 1-stage bulboprostatic anastomotic urethroplasty for posterior urethral ruptures are evaluated. A total of 63, 1-stage delayed repairs of complete posterior urethral ruptures in 60 men with at least 1-year followup were reviewed. Two ruptures were due to gunshot wounds and 58 were secondary to a pelvic fracture. There were 58 repairs done by the perineal approach and 5 required an abdominal perineal approach. Surgical complications included 2 (3%) rectal injuries, 3 (5%) repeat strictures that required reoperation and 20 (32%) repeat strictures that required dilation or visual internal urethrotomy. By 1 year after surgery all patients had a patent urethra and did not require further treatment. At 1 year 43 (72%) patients voided normally, 5 (8.3%) were areflexic and performed self-catheterization, 5 (8.3%) had urge incontinence and 5 (8.3%) had mild stress incontinence requiring no treatment. Moderate stress incontinence responded to imipramine in 1 case and collagen injection in 1. Of the patients who were potent preoperatively 31 (52%) remained potent postoperatively. Of the 29 (48%) patients who were impotent preoperatively and immediately postoperatively 9 regained potency at 1 year. However, at 1 year, the quality of erections of the 40 potent men was normal in only 22 (37%) and fair to poor in 18 (30%). The 1-stage delayed bulboprostatic anastomotic urethroplasty has a good long-term result with little morbidity for treatment of posterior urethral ruptures in men.

Management of Postoperative Obstruction after Bulboprostatic Anastomotic Urethroplasty for Membranous Urethral Defects Secondary to Pelvic Fracture

To present our experience in the management of postoperative obstruction after bulboprostatic anastomotic urethroplasty for post-traumatic membranous urethral defects secondary to pelvic fracture. Between 1979 and 1998 we managed 25 patients with postoperative posterior urethral obstruction after bulboprostatic anastomotic urethroplasty. Of these patients, 17 had undergone one repair and 8 had undergone more than one repair. One case had multiple perineal fistulae. Visual urethrotomy was done in 3 patients, 1 had cross union at the site of the anastomosis, and the other 2 had short passable strictures. In cases of obliterated strictures, bulboprostatic anastomosis was done in 6 patients via the perineal route and in 10 patients via the transpubic route. In 6 patients the urethral obstruction was due to new bone formation (callus) in the pubic gap (after pubectomy) pressing on the anastomatic line, and these cases were treated by removal of the callus. After 1-6 years of follow up (mean 3.16 years) the outcome of the 3 patients who underwent visual urethrotomy was good. Eleven of the 16 patients who underwent anastomotic urethroplasty (68.7%) void well, 2 patients had fair results and the remaining 3 (18.7%) had restenosis. In the 6 patients who had new bone formation in the pubic gap, the obstruction was relieved by removal of the callus. Visual urethrotomy is limited to very short passable urethral strictures, we do not recommend cutting on the light. End-to-end anastomosis was performed in obliterated strictures. Removal of the new bone formation from the pubectomy gap relieved the urethral obstruction.

Transperineal bulbo-prostatic anastomotic urethroplasty.

Transperineal bulbo-prostatic anastomotic urethroplasty is the procedure of choice for the treatment of pelvic-fracture urethral distraction defects. Surgery is usually performed at 3-6 months after the injury. Endoscopic urethroplasty may prove to be an alternative if long-term follow-up confirms the initial enthusiasm for the procedure. Alternative urethroplasty techniques have not proved appropriate in long-term follow-up. The procedure depends on a progressive series of steps to capitalise on the elastisity of the urethra and then straighten out the natural curve of bulbar urethra. A retropubic or (truly) transpubic approach is rarely necessary except for complicated problems. The restricture rate is approximately 10% and is generally associated with poor vascularity. Other complications are generally the complications of the original injury rather than of the procedure itself.

Management of Posterior Urethral Strictures Secondary to Pelvic Fractures in Children

Bulboprostatic anastomotic urethroplasty was performed in 20 children with posterior urethral strictures secondary to bony pelvic fractures. The approach was perineal in 4 children and transpubic abdominoperineal in 16, with good postoperative results in 100 and 62.5%, respectively. In some children the urethral disruption occurred within the prostate itself and not at the prostatomembranous junction. In such cases the proximal sphincteric mechanism may be at risk and immediate repair of the injury is advisable.In the case of common prostatomembranous disruption displacement of the urethra may be significant. In such cases a transpubic approach is preferable. If the proximal sphincteric mechanism is deranged, it can be managed at the same time.

The treatment of sphincter strictures.

A group of 25 patients with strictures of the membranous urethra following transurethral resection of the prostate (TURP) were investigated and treated initially by careful urethral dilatation. This controlled the stricture in 14 patients, 6 of whom continued with occasional dilatation or self-catheterisation to maintain control; 8 required an artificial urinary sphincter (AUS) and 2 required a "clam" ileocystoplasty for detrusor instability. Eleven had persistent or recurrent strictures requiring urethroplasty. Nine underwent bulbo-prostatic anastomotic urethroplasty, 4 with simultaneous bladder neck reconstruction and 5 with subsequent implantation of an AUS; 2 had a preputial patch urethroplasty with subsequent implantation of an AUS. Four of the 9 patients with a urethroplasty and an AUS are satisfactory, 1 developed a recurrent stricture and 2 developed erosions. Two of those with a bulbo-prostatic anastomosis and bladder neck reconstruction are satisfactory and 2 are incontinent. These results were compared with those of 18 other patients who underwent bladder neck reconstruction and 12 who had a urethroplasty in conjunction with an AUS for reasons other than a post-TURP sphincter stricture. The success rate of bladder neck reconstruction was 55% and the success rate of urethroplasty in conjunction with an AUS was 83%, but the main complication of AUS implantation, erosion, was a more serious problem than failure of bladder neck reconstruction. However, the much higher success rate makes AUS implantation a more satisfactory procedure. Surgery should be avoided if at all possible and reliance placed on urethral dilatation.