Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Modified Urethral Graciloplasty Cross-Innervated by the Pudendal Nerve for Postprostatectomy Urinary Incontinence: Cadaveric Simulation Surgery and a Clinical Case Report

  • Hisashi Sakuma (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College) ;
  • Masaki Yazawa (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Makoto Hikosaka (Department of Plastic and Reconstructive Surgery, National Center for Child Health and Development) ;
  • Yumiko Uchikawa-Tani (Department of Plastic and Reconstructive Surgery, Saiseikai Utsunomiya Hospital) ;
  • Masayoshi Takayama (Department of Plastic and Reconstructive Surgery, Nasu Red Cross Hospital) ;
  • Kazuo Kishi (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine)
  • Received : 2022.05.11
  • Accepted : 2022.11.30
  • Published : 2023.11.15
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Abstract

An artificial sphincter implanted in the bulbous urethra to treat severe postprostatectomy urinary incontinence is effective, but embedding-associated complications can occur. We assessed the feasibility, efficacy, and safety of urethral graciloplasty cross-innervated by the pudendal nerve. A simulation surgery on three male fresh cadavers was performed. Both ends of the gracilis muscle were isolated only on its vascular pedicle with proximal end of the obturator nerve severed and transferred to the perineum. We examined whether the gracilis muscle could be wrapped around the bulbous urethra and whether the obturator nerve was long enough to suture with the pudendal nerve. In addition, surgery was performed on a 71-year-old male patient with severe urinary incontinence. The postoperative 12-month outcomes were assessed using a 24-hour pad test and urodynamic study. In all cadaveric simulations, the gracilis muscles could be wrapped around the bulbous urethra in a γ-loop configuration. The length of the obturator nerve was sufficient for neurorrhaphy with the pudendal nerve. In the clinical case, the postoperative course was uneventful. The mean maximum urethral closure pressure and functional profile length increased from 40.7 to 70 cm H2O and from 40.1 to 45.3 mm, respectively. Although urinary incontinence was not completely cured, the patient was able to maintain urinary continence at night. Urethral graciloplasty cross-innervated by the pudendal nerve is effective in raising the urethral pressure and reducing urinary incontinence.

Keywords

Acknowledgement

The authors thank Clinical Anatomy Laboratory at Keio University, School of Medicine for their cooperation.

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