GRACILIS URETHRAL MYOPLASTY - PRELIMINARY EXPERIENCE USING AN AUTOLOGOUS URINARY SPHINCTER FOR POSTPROSTATECTOMY INCONTINENCE

Purpose: We investigated the effect of a neurovascular intact gracilis muscle urethral wrap to restore urinary continence in men with severe stress urinary incontinence after radical retropubic prostatectomy. M aterials and Methods: Three men with stress incontinence after radical retropubic prostatectomy and external beam radiation therapy for aden ocarcinoma of the prostate underwent gracilis urethral myoplasty. Vide o urodynamic evaluation and cystourethroscopy revealed Valsalva leak p oint pressure of less than 40 cm, water and a damaged urinary sphincte r mechanism in all 3 patients, One man underwent concomitant ileocysto plasty. Results: At 6 to 24-month followup all patients reported impro ved continence. Mean Valsalva leak point pressure increased from 26.3 +/- 3.2 cm. water before to 83.0 +/- 32.1 cm, water after surgery, The gracilis muscle urethral wrap did not have a deleterious effect on er ectile function or ambulation, Complications included 1 wound infectio n. Conclusions: An autologous gracilis muscle urinary neosphincter can be constructed in the bulbous urethra in a fashion similar to that of the artificial urinary sphincter with encouraging results in this pre liminary series, The gracilis neosphincter may be an alternative to th e artificial sphincter, especially in patients at higher risk for comp lications, such as after radiation and cryotherapy.