BLADDER OUTLET RECONSTRUCTION - FATE OF THE SILICONE SHEATH

The placement of a 1.5 cm. wide silicone sheath around a newly constru cted urethra/bladder neck to ensure maintenance of repair length and t o facilitate future placement of a sphincter cuff was reported by our institution in 1985. We present our long-term followup and new recomme ndations for use of the silicone sheath. A total of 15 silicone sheath s was placed between March 1981 and July 1984. Of the sheaths 14 were placed at the time of urinary reconstruction around the Young-Dees-Lea dbetter bladder neck repair and 1 was placed after erosion of an artif icial urinary sphincter cuff. Of the 15 sheaths 10 have eroded into th e urethra and 4 sheaths remain in situ. Another sheath was replaced 2 years after its original insertion with an artificial urinary sphincte r cuff. Mean time to erosion was 48.2 months, with a range of 2 to 108 months. Long-term followup of 10 patients revealed that 4 ultimately required ligation of the bladder neck and construction of continent st oma after erosion, 1 is dry after placement of a bulbar artificial uri nary sphincter, 2 remain dry after removal of the eroded sheath alone, 2 required bladder neck revision to achieve continence after erosion and the most recent patient remains diverted with a suprapubic tube. A ll 4 patients with sheaths still remaining are dry without evidence of erosion (mean duration 116 months). These long-term results using a s ilicone wrap around a newly constructed bladder neck reveal an unaccep tably high rate of erosion. Therefore, we no longer recommend or suppo rt the use of the silicone sheath in the manner we have described for bladder neck reconstruction.