Introduction: The use of artificial urinary sphincters can improve urinary incontinence after radical prostatectomies; however, complications can arise. We hypothesized that dynamic graciloplasty improves urethral sphincter reconstruction. Materials and Methods: Models of urethral sphincter muscle reconstruction were developed in 5 adult rabbits by wrapping the gracilis muscle flap around the urethra. Intra-urethral pressure was measured in each of the models before reconstruction (control), after reconstruction, and after electrical stimulation of the flap in reconstructed models (stimulated models). Results: The mean maximum urethral closure pressure was significantly greater in the reconstruction model (69.7 (66.5-115.8) mm Hg) than in the control model (39.2 (33.7-49.6) mm Hg). The mean integral of the urethral pressure and urethral length was also significantly greater in the reconstruction model than in the control model. Furthermore, sphincter tightening was enhanced by the electrical stimulation of the flap. Conclusions: Our results support our hypothesis that the functional reconstruction of urethral sphincters using muscle flaps is promising for the treatment of urinary incontinence.

Keywords:
Urethral sphincter incompetence, Pudendal nerve, Nerve anastomosis, Dynamic graciloplasty
1.
van der Poel HG, Tillier C, de Blok WM, Acar C, van Muilekom EH, van den Bergh RC: Interview-based versus questionnaire-based quality of life outcomes before and after prostatectomy. J Endourol 2013;27:1411-1416.
2.
Foley FE: An artificial sphincter; a new device and operation for control of enuresis and urinary incontinence. J Urol 1947;58:250-259.
3.
Scott FB, Bradley WE, Timm GW: Treatment of urinary incontinence by an implantable prosthetic urinary sphincter. J Urol 1974;112:75-80.
4.
Trigo Rocha F, Gomes CM, Mitre AI, Arap S, Srougi M: A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes. Urology 2008;71:85-89.
5.
Pickrell KL, Broadbent TR, Masters FW, Metzger JT: Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg 1952;135:853-862.
6.
Wexner SD, Gonzalez-Padron A, Rius J, Teoh TA, Cheong DM, Nogueras JJ, Billotti VL, Weiss EG, Moon HK: Stimulated gracilis neosphincter operation. Initial experience, pitfalls, and complications. Dis Colon Rectum 1996;39:957-964.
7.
Young HH: An operation for the cure of incontinence of urine. Surg Gynecol Obstet 1919;28:84-90.
8.
Dees JE: Congenital epispadias with incontinence. J Urol 1949;62:513-522.
9.
Blaivas JG, Jacobs BZ: Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol 1991;145:1214-1218.
10.
Pérez LM, Smith EA, Parrott TS, Broecker BH, Massad CA, Woodard JR: Submucosal bladder neck injection of bovine dermal collagen for stress urinary incontinence in the pediatric population. J Urol 1996;156(2 pt 2):633-636.
11.
Léon P, Chartier-Kastler E, Rouprêt M, Ambrogi V, Mozer P, Phé V: Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence. BJU Int 2015;115:951-957.
12.
Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN; Young Academic Urologists Functional Urology Group: The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 2013;63:681-689.
13.
Deming CL: Transplantation of the gracilis muscle for incontinence of urine. JAMA 1926;86:822-825.
14.
Pickrell K, Georgiade N, Crawford H, Maguire C, Boone A: Gracilis muscle transplant for correction of urinary incontinence in male children. Ann Surg 1956;143:764-779.
15.
Williams NS, Hallan RI, Koeze TH, Watkins ES: Construction of a neorectum and neoanal sphincter following previous proctocolectomy. Br J Surg 1989;76:1191-1194.
16.
Janknegt RA, Baeten CG, Weil EH, Spaans F: Electrically stimulated gracilis sphincter for treatment of bladder sphincter incontinence. Lancet 1992;340:1129-1130.
17.
van Aalst VC, Werker PM, Stremel RW, Perez Abadia GA, Petty GD, Heilman SJ, Palacio MM, Kon M, Tobin GR, Barker JH: Electrically stimulated free-flap graciloplasty for urinary sphincter reconstruction: a new surgical procedure. Plast Reconstr Surg 1998;102:84-91.
18.
Palacio MM, Van Aalst VC, Perez Abadia GA, Stremel RW, Werker PM, Ren X, Petty GD, Heilman SJ, Van Savage JG, Garcia Fernandez A, Kon M, Tobin GR, Barker JH: Muscular urinary sphincter: electrically stimulated myoplasty for functional sphincter reconstruction. J Urol 1998;160:1867-1871.
19.
Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D: Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 2003;238:203-213.
20.
Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD: Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569-1574.
21.
Chambers SK, Meng X, Youl P, Aitken J, Dunn J, Baade P: A five-year prospective study of quality of life after colorectal cancer. Qual Life Res 2012;21:1551-1564.
22.
Sato T, Konishi F, Endoh N, Uda H, Sugawara Y, Nagai H: Long-term outcomes of a neo-anus with a pudendal nerve anastomosis contemporaneously reconstructed with an abdominoperineal excision of the rectum. Surgery 2005;137:8-15.
23.
Sato T, Konishi F, Kanazawa K: End-to-side pudendal nerve anastomosis for the creation of a new reinforcing anal sphincter in dogs. Surgery 2000;127:92-98.
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2015
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