title: Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinence.
abstract: OBJECTIVE
  To describe a technique of externally bulking the urethra with a soft-tissue graft before placing another artificial urinary sphincter (AUS), as when placing another AUS for recurrent male stress urinary incontinence (SUI) other manoeuvres, e.g. placing a tandem cuff or transcorporal cuff, must be used to obtain urinary continence in an atrophic urethra, and each is associated with morbidity.
  
  
  METHODS
  From January 2003 to July 2004, five patients (mean age 74 years, range 62-84) treated by radical prostatectomy were referred for recurrent SUI after placing an AUS (four, including one with urethral erosion) or a male sling (one, with a resulting atrophic urethra). Each patient was treated with an external urethral bulking agent (Surgisis) ES, Cook Urological, Spencer, Indiana) and had an AUS placed.
  
  
  RESULTS
  In each patient the greatest urethral circumference was <4 cm. To place a functional 4 cm cuff, the diameter of the urethra was enhanced by wrapping it with Surgisis ES. Continence was significantly improved in all patients except one 84-year-old man who had the replanted artificial sphincter removed because of erosion 14 months after surgery.
  
  
  CONCLUSIONS
  In cases of severe recurrent SUI from urethral atrophy after placing an AUS, externally bulking the urethra with Surgisis ES before placing another AUS is well tolerated, and gives satisfactory results.
authors.affiliation: Department of Urology, University of California, San Francisco, CA 94143, USA.
authors.forename: Nadeem U
authors.initials: NU
authors.lastname: Rahman
authors.forename: Thomas X
authors.initials: TX
authors.lastname: Minor
authors.forename: Donna
authors.initials: D
authors.lastname: Deng
authors.forename: Tom F
authors.initials: TF
authors.lastname: Lue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000517:prevention & control; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial