title: A two staged treatment procedure for the difficult to treat bladder neck contractures with concomitant incontinence. In the search of a solution to a complex problem.
abstract: OBJECTIVE
  To examine the efficacy of a two staged treating strategy with the use of a non-permanent urethral ALLIUM(®) stent for the management of recurrent bladder neck stenosis and subsequently the use of an artificial sphincter AUS800(®) by AMS for the management of the incontinence.
  
  
  METHODS
  We progressively identified patients eligible for the study creating a population of cases with recurrent bladder neck stenosis and concomitant incontinence occurring after the last intervention for the stenosis. Efficacy for the treatment of the stenosis was defined as no recurrence both prior and post to the sphincter placement and efficacy for the treatment of the incontinence was defined as continence (0-1pads) after the sphincter placement.
  
  
  CONCLUSIONS
  14 white males with a mean age of 66.21, ranging from 59 to 73 years consisted the population of the study. All patients had severe stress incontinence following the last transurethral resection. The efficacy of the treatment of the bladder neck stenosis was 93% (13/14) while the efficacy for the treatment of the incontinence was 100%. A single patient had a recurrent bladder neck stenosis after the artificial sphincter placement and was treated with transurethral resection using a long pediatric 13 F resectoscope at 12 months. Our limitations is the absence of a control group and the small number of patients enrolled, with a relatively short time of follow up.
  
  
  CONCLUSIONS
  In our series we propose the use of a non-permanent urethral ALLIUM(®) stent for 6 months in order to control the growth of fibrotic scar tissue, a further 6 months follow up for recurrence, and then placement of an artificial sphincter. The results are very promising both on stabilizing the vesicourethral stenosis, and on patient safety and tolerability.
authors.affiliation: 1st University Urology Clinic, Laiko Hospital. yianton@hotmail.com.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Adamakis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Fragkiadis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Katafigiotis
authors.forename: Giorgos
authors.initials: G
authors.lastname: Kousournas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stravodimos
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Constantinides
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D015607:Stents; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D013521:Urologic Surgical Procedures, Male