Use of Solovov - Badenoch principle in treating severe and recurrent vesico-urethral anastomosis stricture after radical retropubic prostatectomy: Technique and long-term results

OBJECTIVE: • To report our experience in the management of patients with combined urinary incontinence and stricture after radical prostatectomy with a two-step approach: urethroplasty with a ' pullthrough ' technique after the Solovov - Badenoch principle; and artificial urinary sphincter (AUS) insertion after 8 - 10 months. PATIENTS AND METHODS: • We retrospectively evaluated a cohort of 11 patients treated between September 2001 and January 2010. RESULTS: • There were no intraoperative complications in either procedure. • After urethroplasty one patient was unable to empty the bladder with complete urine retention without urethral stricture (treatment failure). • At 6 months after the urethroplasty 10 patients were completely incontinent and received AUS. • One previously irradiated patient developed urethral erosion 6 months after AUS implantation and underwent complete removal of the device. • After a mean (range) follow-up of 65 (19 - 119) months, nine patients (81.8%) were continent with no post-void residual urine and a perfectly functioning AUS. CONCLUSION: • Our experience with a two-step approach (combined suprapubic/ transperineal redo anastomosis and AUS placement) shows that redo vesico-urethral anastomosis is easier than pure transperineal approaches with good results in restoring patency and that the transperineal step provides a dedicated operative field for AUS implantation with reduced risks of perioperative complications.