title: Management of anastomotic stricture after artificial urinary sphincter placement in patients who underwent salvage prostatectomy.
abstract: OBJECTIVE
  To report on a safe endoscopic management technique for the treatment of an anastomotic stricture (AS) in patients with an artificial urinary sphincter (AUS).
  
  
  METHODS
  Five patients with a history of salvage prostatectomy after radiation therapy that developed an AS after AUS placement were treated with a rigid ureteroscope and a Holmium YAG (Ho: YAG) laser to incise the AS. The AUS was opened and deactivated but not decoupled or removed during the procedure. The rigid ureteroscope allowed complete control of the laser fiber to incise the stricture at the 3 and 9 o' clock positions and then circumferentially.
  
  
  RESULTS
  There were no intraoperative complications and the mean operative time was 42.6 minutes. Of the 5 patients who underwent holmium laser incision of an AS after AUS placement, none developed AUS malfunction or required device replacement. No patients reported worsening of urinary incontinence after treatment. Two patients required repeat holmium laser incision for AS recurrence.
  
  
  CONCLUSIONS
  Using a rigid ureteroscope and a holmium laser to incise an AS after AUS placement seems to be a safe management option that does not damage the AUS or result in worsening incontinence. This treatment strategy provides an endoscopic alternative to using open surgical technique to uncouple or remove the AUS while treating the AS.
authors.affiliation: Division of Urology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Weissbart
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Dean
authors.initials: D
authors.lastname: Elterman
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003558:Cystoscopy; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D016879:Salvage Therapy; D020709:Ureteroscopes; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D016741:Urinary Sphincter, Artificial