Management of the incontinent patient with a sphincteric stricture following radical prostatectomy

Abstract

Purpose of review: The 5-year and 15-year life expectancy following the treatment of localized prostate cancer is excellent. Patients may develop rare but devastating complications following the surgery for prostate cancer. The purpose of this review is to summarize the available literature to date surrounding the management of the incontinent patient with a concomitant bladder neck contracture (BNC), or sphincteric stricture, following radical prostatectomy.

Recent findings: The literature consists of several case series, but no clinical trials exist to provide an evidence-based approach to the incontinent patient with concomitant BNC. Fortunately, this is a relatively rare clinical scenario and most cases are successfully managed with urethral dilatation or endoscopic techniques. Multiple endoscopic techniques are available. In addition, some authors include injectable agents in their armamentarium for the treatment of BNC. Open reconstructive techniques or permanent urinary diversion may be necessary in rare cases. Both male slings and artificial urinary sphincter may be considered for the management of concomitant urinary incontinence. Some authors suggest it is safe to proceed with simultaneous artificial urinary sphincter implantation at the time of endoscopic management of the BNC.

Summary: Management of the incontinent patient with concomitant BNC represents a challenging situation for the urologist. Several techniques are available to stabilize the BNC before safely proceeding with surgery for urinary incontinence. For the rare, complex case that has failed endoscopic management, referral to a surgeon experienced in reconstructive techniques is warranted.