Salvage Prostatectomy With Bladder Neck Closure, Continent Catheterizable Stoma and Bladder Augmentation: Feasibility and Patient Reported Continence Outcomes at 32 Months

Purpose: Salvage prostatectomy after radiation therapy is associated with a high rate of urinary incontinence. To avoid this outcome in candidates with preexisting voiding symptoms, such as frequency, urgency and urge incontinence, we performed concurrent bladder augmentation with bladder neck closure and a catheterizable stoma. Urinary incontinence and patient satisfaction were evaluated. Materials and Methods: Between October 2000 and February 2003, 11 patients underwent salvage prostatectomy with bladder neck closure and ileal augmentation using catheterizable appendicovesicostomy or Monti ileovesicostomy. Self-reported outcome measures included patient questionnaires and the validated Incontinence Symptom Index. Results: The indication for surgery was recurrent adenocarcinoma of the prostate in 10 patients and invasive squamous cell carcinoma of the urethra in 1. All patients underwent prior radiation. Mean ± SD followup after prostatectomy and reconstruction was 32 ± 7.5 months. The physician noted that 8 of 11 patients (73%) were dry. Nine of 11 patients (82%) returned the questionnaire. Only 2 of 9 patients (22%) reported using absorbent protection. By self-report and the Incontinence Symptom Index 4 of 9 patients (44%) reported no leakage and only 3 (33%) had leakage more frequently than once weekly. Three of 11 patients (27%) required stomal revision at an average of 24 ± 17 months, of whom 2 still reported difficult catheterization. Seven of 9 patients (77%) reported that they would repeat the procedure. Conclusions: Continent catheterizable bladder augmentation is a technically feasible option for men requiring salvage prostatectomy. The postoperative continence rate is excellent and it appears superior to that in the literature for salvage prostatectomy with vesicourethral anastomosis.