You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-01 RECONSTRUCTION OF BULBO-MEMBRANOUS URETHRAL STRICTURES AFTER SURGERY FOR BENIGN PROSTATIC HIPERPLASIA WITH PRESERVATION OF CONTINENCE Reynaldo Gomez, Juan Carlos Castaño, Laura Velarde, and Rodrigo Campos Reynaldo GomezReynaldo Gomez More articles by this author , Juan Carlos CastañoJuan Carlos Castaño More articles by this author , Laura VelardeLaura Velarde More articles by this author , and Rodrigo CamposRodrigo Campos More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bulbo-membranous urethral strictures (BMUS) after surgery for BPH are challenging because the internal sphincter has been removed and continence relay on the external sphincter, which is located just at the site of the stricture; any attempt to reconstruction may jeopardize continence. Anatomical studies have shown that the rhabdosphincter is separated from the membranous urethra by a sheath of connective tissue [1]. We developed a novel technique performing a meticulous dissection of this sheath to separate the muscle from the urethral wall, thus performing an intra-sphincteric anastomosis without disturbing the sphincteric function METHODS Patients with BMUS after TURP or open prostatectomy (OP) who failed dilation and/or internal urethrotomy were reconstructed with a BPA with preservation of the external sphincter. The bulbo-membranous junction is approached dorsally and the bulb is mobilized only from one side, without detachment from the perineal body. The bulbo-membranous junction is isolated with a vessel loop and the bulbar vessels retracted posteriorly. The sheath of the membranous urethra is opened circumferentially, carefully reflecting the circular muscle fibers of the external sphincter until exposure of the urethral wall is obtained. Gentle blunt proximal dissection along this connective tissue plane allows separating the muscle away from the urethra up to the prostatic apex, where healthy urethra is found to perform the anastomosis RESULTS From January 2010 to October 2015 we operated 23 patients, 14 after TURP and 9 after OP. All had membranous or bulbo-membranous strictures; bladder neck contractions were excluded. Mean age was 68 years (57 – 81). Except 4 patients, all have been treated with either dilation and or one or more DVIUs; seven were with a suprapubic tube. Mean length of stricture was 3 cm (1 - 4.5), mean time from surgery to reconstruction was 30 months (2 - 153). At a mean follow-up of 34 months (1 - 68) 19/23 patients were completely dry or using only one security pad (83% success). There were two Clavien I and one Clavien III complications and no stricture recurrence. CONCLUSIONS Excision and bulbo-prostatic anastomosis with sphincter sparing for BMUS after BPH surgery is feasible and safe. Our technique allows preserving continence in most patients and to our knowledge it has not been described before. A larger series and reproduction in other centers are needed to validate our results. 1. Dalpiaz O et al. Anatomical approach for surgery of the male posterior urethra. BJU Int 2008; 102: 1448-1451. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e998 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Reynaldo Gomez More articles by this author Juan Carlos Castaño More articles by this author Laura Velarde More articles by this author Rodrigo Campos More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...