Mb. Chancellor et al., GRACILIS URETHRAL MYOPLASTY - PRELIMINARY EXPERIENCE USING AN AUTOLOGOUS URINARY SPHINCTER FOR POSTPROSTATECTOMY INCONTINENCE, The Journal of urology, 158(4), 1997, pp. 1372-1375
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.