Dr. Sean Elliott, MD
Reconstructive Urologist
Repair of Vesicourethral Anastomotic Stricture
Also known as scar tissue at the connection of the bladder and urethra after radical prostatectomy; transperineal repair by urethroplasty.
One way to treat prostate cancer is radical prostatectomy which means removal of the entire prostate gland.
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Bladder
Prostate
Urethra
Rectum
Figure 1. Male Bladder Anatomy (side-view).
Because the urethra runs through the middle of the prostate and is connected to it, about 1-2 inches of urethra is removed when the prostate is removed.
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Bladder
Prostate
Urethra
Rectum
The bladder is pulled down and then the urethra and “neck” of the bladder are sewn together.
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Bladder
Urethra
Rectum
This new connection usually works well. But about 5% of the time, a scar tissue (shown in green) can develop at the connection. This risk of developing a scar tissue can go up to 15% if a man received radiation therapy in addition to prostate removal. This scar tissue can block the flow of urine.
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Bladder
Urethra
Rectum
Balloon dilation is usually the first choice to treat this scar tissue. When balloon dilation or cutting with a scope have not worked at keeping the scar tissue open, some men will choose to pass a catheter through the area about once a day to keep the scar open.
Surgery to remove the scar tissue is another option. This surgery can be done be either going through the perineum (the area between the scrotum, or ball sack) and the rectum. This approach is shown with a blue arrow. Another approach is to fix the scar tissue with a surgery through the abdomen (shown with a pink arrow). The choice of which approach to use depends on several factors and can be discussed with Dr. Elliott.
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Bladder
Urethra
Rectum
Balloon dilation is usually the first choice to treat this scar tissue. When balloon dilation or cutting with a scope have not worked at keeping the scar tissue open, some men will choose to pass a catheter through the area about once a day to keep the scar open.
If going through the perineum, then an incision is made in the skin and the urethra is cut where it connects to the bladder.
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Bladder
Urethra
Rectum
If going through the perineum, then an incision is made in the skin and the urethra is cut where it connects to the bladder. The urethra is then mobilized by cutting along its lengthening, freeing up its connections to the surrounding tissue. This will allow the urethra to then stretch and reach the bladder.
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Bladder
Urethra
Rectum
The scar tissue is then removed from the bladder “neck”.
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Rectum
Bladder
Urethra
The urethra and “neck” of the bladder are sewn together. Patients will frequently be incontinent after this procedure and an artificial urinary sphincter can be placed at a later date, once we are sure the scar is not going to come back (usually 6 months later).
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Back
Bladder
Urethra
Rectum