Mb. Chancellor et al., GRACILIS URETHROMYOPLASTY - AN AUTOLOGOUS URINARY SPHINCTER FOR NEUROLOGICALLY IMPAIRED PATIENTS WITH STRESS-INCONTINENCE, Spinal cord, 35(8), 1997, pp. 546-549
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.