Adamakis et al. Journal of Medical Case Reports 2012, 6:94 http://www.jmedicalcasereports.com/content/6/1/94 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Recurrent urethrovesical anastomotic strictures following artificial urinary sphincter implantation: a case report Ioannis Adamakis1, Stavros I Tyritzis1*, Ioanna Vasileiou2, Ioannis Katafigiotis1, Ioannis Leotsakos1, Sotiria Fergadaki1, Konstantinos G Stravodimos1 and Constantinos A Constantinides1 Abstract Introduction: The management of an anastomotic stricture after a radical prostatectomy can become a complex and difficult situation when an artificial urinary sphincter precedes the formation of the stricture. The urethral narrowing does not allow the passage of the routinely used urological instruments and no previous reports have suggested alternate approaches. Case presentation: We present the case of a 68-year-old Greek man diagnosed as having a recurrent anastomotic stricture approximately two years after a radical prostatectomy and three years after the implantation of an artificial urinary sphincter, and propose novel alternate methods of treatment. Our patient was first subjected to stricture incision with the use of a rigid ureteroscope with a holmium:yttrium-aluminium-garnet laser fiber, which was followed by a second successful attempt with the use of a pediatric resectoscope. After a one-year follow-up, our patient is doing well, with no evidence of recurrence. Conclusions: To the best of our knowledge, this is the first report of the management of recurrent urethral strictures following an artificial urinary sphincter implantation. Minimal invasive techniques with the use of small caliber instruments may offer efficient treatment options, diminishing the danger of urethral corrosion. Introduction Despite improvements and refinements in the surgical techniques used for radical prostatectomy (RP), compli- cations still exist. The commonest are incontinence and loss of erectile function. The next most common com- plication, with rates ranging from 0.48% to 32%, is the formation of urethrovesical anastomosis (UVA) stricture [1,2]. These strictures tend to have a high incidence of recurrence and several treatment options have been pro- posed such as dilatation, endoscopic cold-knife incision, urethral stent placement, electrocautery resection, ana- stomotic urethroplasty and intermittent self-catheteriza- tion. However, the problem becomes very complex in the presence of a previously placed artificial urinary sphincter (AUS). The approach to the stricture can be extremely difficult by the routinely used techniques and * Correspondence: statyr@freemail.gr 1Department of Urology, Athens University Medical School-LAIKO Hospital, Athens, Greece Full list of author information is available at the end of the article instruments. Until now, the management of recurrent contractures was simultaneous or before the placement of an AUS [3-5]. To the best of our knowledge, we present a case where novel methods were used to treat this complex and difficult situation. Case presentation A 68-year-old Greek man was referred to our depart- ment for evaluation two years after an open retropubic RP. He presented with lower urinary tract symptoms and symptoms of urinary incontinence. His medical his- tory was notable for hypertension and atrial fibrillation. Our patient was assessed with cystourethrography and cystourethroscopy and the presence of the anastomotic stricture was verified. An endoscopic cold-knife incision was performed successfully. Six months later, and after the recurrence of a urethral stricture was ruled out, our patient underwent an AUS placement for the manage- ment of incontinence. The decision to implant an AUS © 2012 Adamakis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.