Gracilis urethral myoplasty: Preliminary experience using an autologous urinary sphincter for post-prostatectomy incontinence

Purpose: We investigated the effect of a neurovascular intact gracilis muscle urethral wrap to restore urinary continence in men with severe stress urinary incontinence after radical retropubic prostatectomy. Materials and Methods: Three men with stress incontinence after radical retropubic prostatectomy and external beam radiation therapy for adenocarcinoma of the prostate underwent gracilis urethral myoplasty. Video urodynamic evaluation and cystourethroscopy revealed Valsalva leak point pressure of less than 40 cm. water and a damaged urinary sphincter mechanism in all 3 patients. One man underwent concomitant ileocystoplasty. Results: At 6 to 24-month followup all patients reported improved continence. Mean Valsalva leak point pressure increased from 26.3 ± 3.2 cm. water before to 83.0 ± 32.1 cm. water after surgery. The gracilis muscle urethral wrap did not have a deleterious effect on erectile function or ambulation. Complications included 1 wound infection. Conclusions: An autologous gracilis muscle urinary neosphincter can be constructed in the bulbous urethra in a fashion similar to that of the artificial urinary sphincter with encouraging results in this preliminary series. The gracilis neosphincter may be an alternative to the artificial sphincter, especially in patients at higher risk for complications, such as after radiation and cryotherapy.