The online version of this article (doi:10.1186/1752-1947-6-94) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
ST and IV drafted the manuscript and gathered patient data. ST, IA, KG analyzed and interpreted the data from our patient. IL, IK and SF followed up our patient and recorded the outcomes. IA performed the surgical operations, assisted by ST, and supervised the writing of the manuscript. CA supervised the writing of the manuscript and made critical revisions. All authors read and approved the final manuscript.
The management of an anastomotic stricture after a radical prostatectomy can become a complex and difficult situation when an artificial urinary sphincter precedes the formation of the stricture. The urethral narrowing does not allow the passage of the routinely used urological instruments and no previous reports have suggested alternate approaches.
We present the case of a 68-year-old Greek man diagnosed as having a recurrent anastomotic stricture approximately two years after a radical prostatectomy and three years after the implantation of an artificial urinary sphincter, and propose novel alternate methods of treatment. Our patient was first subjected to stricture incision with the use of a rigid ureteroscope with a holmium:yttrium-aluminium-garnet laser fiber, which was followed by a second successful attempt with the use of a pediatric resectoscope. After a one-year follow-up, our patient is doing well, with no evidence of recurrence.
To the best of our knowledge, this is the first report of the management of recurrent urethral strictures following an artificial urinary sphincter implantation. Minimal invasive techniques with the use of small caliber instruments may offer efficient treatment options, diminishing the danger of urethral corrosion.
Besarini D, Amoroso P, Kirky R: Bladder neck contracture after radical retropubic prostatectomy. BJU Int. 2004, 94: 1245-1247. 10.1111/j.1464-410X.2004.05151.x. CrossRef
Elliot DS, Boone TB: Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol. 2001, 165: 413-415. 10.1097/00005392-200102000-00014. CrossRef
Berlin JW, Ramchandani P, Banner MP, Pollack HM, Nodline CF, Wein AJ: Voiding cystourethrography after radical prostatectomy: Normal findings and correlation between contrast extravastation and anastomotic strictures. Am J Roentgenol. 1994, 162: 87-91. CrossRef
Surya BV, Provet J, Johanson K-E, Brown J: Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol. 1990, 143: 755-758. PubMed
Simonato A, Gregori A, Lissiani A, Carmignani G: Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures. Eur Urol. 2007, 52: 1499-1504. 10.1016/j.eururo.2007.03.053. CrossRefPubMed
Rachmandani P, Banner MP, Berlin JW, Dannenbaum MS, Wein AJ: Vesicourethral anastomotic strictures after radical prostatectomy: efficacy of transurethral balloon dilation. Radiology. 1994, 193: 345-349. CrossRef
- Recurrent urethrovesical anastomotic strictures following artificial urinary sphincter implantation: a case report
Stavros I Tyritzis
Konstantinos G Stravodimos
Constantinos A Constantinides
- BioMed Central