GRACILIS URETHROMYOPLASTY - AN AUTOLOGOUS URINARY SPHINCTER FOR NEUROLOGICALLY IMPAIRED PATIENTS WITH STRESS-INCONTINENCE

Purpose: To investigate the effect of a neurovascularly intact gracili s muscle urethral wrap, to be used to restore urinary continence as a transposed urinary sphincter graft. in patients with neurogenic lower urinary tract dysfunction. Methods: Five neurologically impaired men w ith a denervated and damaged urinary sphincter mechanisms were treated . The etiology of sphincteric insufficiency included sphincter denerva tion in three patients. external sphincterotomy in one, and urethral t rauma due to a chronic indwelling catheter in one, All patients underw ent gracilis urethromyoplasty sphincter reconstruction. Two patients a lso underwent concomitant ileocystoplasty and one patient ileocystosto my because of poor bladder compliance and a bladder capacity of <200 m l. Results: The gracilis urethromyoplasty functioned as a new autologo us sphincter with follow-ups ranging from 6-35 months. The surgery was successful in four patients. Three of the four patients were managed with intermittent catheterization, and one managed by ileocystostomy. The fifth patient continued to require an indwelling urethral catheter . Conclusion: Gracilis urethromyoplasty achieves compression of the ur ethra using a neurovascularly intact muscle graft, The functional uret hral closure, obtained from the gracilis muscle wrap, assures dryness, and permits intermittent self-catheterization. It also avoids the ris ks of infection, erosion. or malfunction associated with the artificic al urinary sphincter. The potential exists for electrical stimulation of this muscle graft to allow volitional control of the neo-sphincter mechanism, and voluntary voiding.