Abdomino–Perineal Repair of Recurrent and Complex Bladder Neck–Prostatic Urethra Contractures

Objective: To evaluate the effectiveness of abdomino–perineal repair in treating complex and recurrent bladder neck–prostatic urethra contractures.Methods: The study included 6 patients retrospectively. Their ages ranged from 66 to 75 years (67.83±8.13, mean + SD). All presented with a long history of voiding difficulty and urinary incontinence. Prior to definitive treatment all the patients had been subjected to multiple unsuccessful transurethral resections of bladder neck–prostatic urethra contractures. They were all subjected to diagnostic work–up including retrograde and voiding urethrogram, urethroscopy and urodynamics. Finally all the patients underwent abdomino–perineal excision of the stenotic area and end to end anastomosis. All of them received simultaneously an artificial urinary sphincter insertion for concurrent sphincteric deficiency and three were subjected simultaneously to clam type ileocystoplasty for intractable detrusor instability. The follow–up ranged from 8 to 56 months (24.42±19.64, mean + SD).Results: The actual surgical time ranged from 3.5 to 5.5 h (4.1+0.4, mean + SD). Five patients void satisfactorily remaining unobstructed through the entire follow–up period, while one has to empty his augmented bladder by means of clean intermittent self catheterization. Five patients are continent and one significantly improved. Major complications due to infection–erosion of the prosthetic material were encountered in one patient.Conclusions: Abdomino–perineal repair is an effective surgical procedure for the management of recurrent and complex bladder neck–prostatic urethra contractures, although it is time consuming and requires in the majority of cases combined techniques in order to achieve optimal results.