Vesicourethral anastomotic stricture and urinary incontinence are severe complications of radical prostatectomy because they cause great impact in the quality of life. Three patients that presented these complications after prostate radical surgery were assessed retrospectively. To treat the stenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincter AMS 800 was implanted to treat the resulting urinary incontinence.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of UrologyUNIFESP, EPM, Department of UrologySciEL

Barreto, Françualdo [UNIFESP]

Dall'oglio, Marcos [UNIFESP]

Srougi, Miguel [UNIFESP]

International braz j urol

Repositório Institucional UNIFESP

552VESICOURETHRAL STENOSIS AFTER PROSTATECTOMYCase ReportInternational Braz J UrolOfficial Journal of the Brazilian Society of UrologyVol. 31 (6): 552-554, November - December, 2005RECURRENT VESICOURETHAL STENOSIS AFTER RADICALPROSTATECTOMY: HOW TO TREAT IT?FRANÇUALDO BARRETO, MARCOS DALL’OGLIO, MIGUEL SROUGIDepartment of Urology, Paulista School of Medicine, Federal University of Sao Paulo, UNIFESP, SaoPaulo, SP, BrazilABSTRACTVesicourethral anastomotic stricture and urinary incontinence are severe complications ofradical prostatectomy because they cause great impact in the quality of life. Three patients that pre-sented these complications after prostate radical surgery were assessed retrospectively. To treat thestenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincterAMS 800 was implanted to treat the resulting urinary incontinence.Key words: prostatectomy; complications; urethral stricture; stents; urinary incontinence; prosthesesand implantsInt Braz J Urol.  2005; 31: 552-4INTRODUCTIONSome complications of radical prostatec-tomy, especially vesicourethral stricture and uri-nary incontinence, have interfered in the patient’squality of life, occurring in approximately 4% and13% of the cases respectively (1). Vesicourethralstenosis treated with endoscopic uretrotomy is effi-cient in 85% of the cases, however in the rest of thecases, stenosis is severe and recurrent and transure-thral procedures are not sufficient to assure bladderneck patency (1). For those individuals UroLume®is an alternative for treating the recurrent urethralstenosis and the artificial sphincter AMS 800 is thebetter choice to solve the consequent urinary incon-tinence.We report our experience with a staged treat-ment of recurrent vesicourethral stricture and uri-nary incontinence after radical prostatectomy, us-ing UroLume® followed by implant of an artificialsphincter AMS 800.CASE REPORTWe present the cases of 3 men that presentedrecurrent vesicourethral stricture and urinary reten-tion after radical retropubic prostatectomy. The meantime of surgical manipulation with urethral catheter-ization, urethrotomy and/or cystostomy, in all patientswas of 140 days (Table-1). All patients were accessedthrough a clinical exam, urethroscopy andurethrography. When the presence of recurrent ure-thral stricture was verified, an UroLume® was indi-cated after 6 month of the radical prostatectomy(Table-2). After positioning the urethral stent with theinexorable evolution to urinary incontinence in allpatients, the artificial sphincter AMS 800 was im-planted after 4 months (Table-3). The mean follow-up was 24 months (12 to 40 months).COMMENTSMany are the determinant factors tovesicourethral stricture such as the anastomotic rup-553VESICOURETHRAL STENOSIS AFTER PROSTATECTOMYTable 1 –  Patients characteristics.Patient   Age  Previous Radiotherapy Manifestations  Catheterization  Time1  82 No Urinary retention 147 days2  64 Yes Urinary retention 153 days3  68 No Urinary retention 120 daysTable 2 –  Place and extension of the stenosis assessed through urethrography.Patient Stenosis Site Stenosis Extension N of Internal Urethrotomies1 Bladder neck 4 cm 52 Bladder neck 3 cm 43 Bladder neck 2 cm 1Patient N of UroLume®      UroLume® (cm) AMS 800 (cm H2O)    Cuff             Continence1          2           2.0 and 3.5              60    4.5 cm                 Yes2          2           3.5 and 3.5              60    4.5 cm                 Yes3          1           2.0              60    4.5 cm                 YesTable 3 –  Results of surgical treatment.ture, infection, extra-leaking of the urine in the anas-tomosis site and previous prostatic surgery. Treatmentwith urethral dilation is little effective while endo-scopic uretrotomy reaches success around 66 to 85%(1). For the treatment of severe recurrent stenosis,UroLume® in association with an artificial sphincterAMS 800 has been a good solution with satisfactionrates of 88 to 100% (2,3). Generally, complete epi-thelization of the UroLume® occurs between 3 to 6months after its insertion (2), this being the reasonwhy we recommend the introduction of an artificialsphincter AMS 800 after 4 months of the first proce-dure and its activation 6 weeks after the implant. Toavoid problems of atrophy and urethral erosion, thepressure on the sphincter cuff should be between 60-70 cm H2O, however, in those patients submitted toprevious radiotherapy we can suggest a pressure of51-60 cm H2O (2).When failure in minimally invasive proce-dures for treating vesicourethral stricture occurs, in-sertion of an urolume is indicated (2). The stent shouldbe the smallest possible to try to preserve the sphinc-teric mechanism. However, its presence can impairthe physiologic functioning of the sphincter, deter-mining urinary incontinence. In these cases, it be-comes necessary the insertion of an artificial sphinc-ter to solve the urinary incontinence.CONFLICT OF INTERESTNone declared.REFERENCES1. Catalona WJ, Carvalhal GF, Mager DE, Smith DS:Potency, continence and complication rates in 1,870554VESICOURETHRAL STENOSIS AFTER PROSTATECTOMYconsecutive radical retropubic prostatectomies. J Urol.1999; 162: 433-8.2. Meulen T, Zambon JV, Janknegt RA: Treatment ofanastomotic strictures and urinary incontinence afterradical prostatectomy with urolume wallstent and AMS800 artificial sphincter. J Endourol. 1999; 13: 517-20.3. Elliott DS, Boone TB: Combined stent and artificialurinary sphincter for management of severe recurrentbladder neck contracture and stress incontinence afterprostatectomy: a long-term evaluation. J Urol. 2001;165: 413-5.Received: May 3, 2005Accepted after revision: September 30, 2005Correspondence address:Dr. Marcos F. Dall’OglioRua Barata Ribeiro, 398 / 501São Paulo, SP, 01308-000, Brazil.Fax: + 55 11 3159-3618E-mail: marcosdallogliouro@terra.com.br

Recurrent vesicourethal stenosis after radical prostatectomy: how to treat it?

Vesicourethral anastomotic stricture and urinary incontinence are severe complications of radical prostatectomy because they cause great impact in the quality of life. Three patients that presented these complications after prostate radical surgery were assessed retrospectively. To treat the stenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincter AMS 800 was implanted to treat the resulting urinary incontinence

Françualdo Barreto

Marcos Dall'oglio

Miguel Srougi

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Barreto, Françualdo

Dall'oglio, Marcos

Srougi, Miguel

Scientific Electronic Library Online - Brazil

LAReferencia - Red Federada de Repositorios Institucionales de Publicaciones Científicas Latinoamericanas

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Recurrent vesicourethal stenosis after radical prostatectomy: how to treat it?

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Scientific Electronic Library Online - Brazil

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