Bulbomembranous urethral strictures (BMUS) after surgery for BPH are challenging, as the internal sphincter located at the bladder neck has been removed by prostatectomy, and urinary continence now depends on the function of the external sphincter, which is located just at the site of the stricture. Consequently, any attempt at stricture reconstruction may jeopardize continence. For this reason, in most cases these patients are only offered conservative management, such as dilation or internal urethrotomy. Unfortunately, these options are seldom curative and the stricture becomes a chronic condition.
Interestingly, anatomic studies have shown that the external sphincter (rhabdosphincter) is separated from the membranous urethra by a sheath of connective tissue, a feature that has previously gone unnoticed (BJU Int 2008; 102:1448-51). Our group developed a novel technique for intra-sphincteric bulbo-prostatic anastomosis (ISBPA) using this anatomic feature. Through a gentle meticulous dissection of this connective tissue sheath, we were able to create a surgical plane that allowed us to separate the muscle from the urethral wall, thus enabling us to resect the stricture and perform a primary anastomosis without disturbing the external sphincter function.
This article describes the surgical steps in this new technique and our promising preliminary results.