Adamakis et al. Journal of Medical Case Reports 2012, 6:94 http://www.jmedicalcasereports.com/content/6/1/94 was taken after evaluating our patient with urethro- scopy, during which a non-functioning external sphinc- ter was observed. Our patient’s post-operative course was uneventful. Our patient had regular follow-up visits with ultrasonography and was free of symptoms for a four-year period. Follow-up of our patient was per- formed with post-void residual and uroflow measure- ments. Three years after the implantation of the AUS, our patient was readmitted with voiding obstructive symptoms and the recurrence of the urethrovesical con- tracture was verified by urethroscopy. The AUS was deactivated at that time. Under general anesthesia, with our patient in the lithot- omy position, an 11F Olympus rigid ureteroscope was passed to the area of the stenosis (Figure 1). A holmium: yttrium-aluminium-garnet (Ho:YAG) laser with a 365 μm end-firing quartz fiber was passed through the working channel at a setting of 1J with a frequency of 10 Hz (10W). This could be increased during the procedure according to the surgeon’s preference. Deep incisions in the scar tissue were performed by direct contact of the laser tip until visualization of the peri-vesical fat. An 18F Foley catheter was then introduced and left in place for three days. Our patient again experienced a recurrence six months later. He was subjected to an endoscopic inci- sion of the stricture with the use of a 9F pediatric resec- toscope (Figure 2). Resection of the stricture was performed (Figure 3) and an 18F Foley catheter was placed. Our patient was discharged two days later after removal of the catheter and evaluation of his urinary function. Six weeks later, the AUS was reactivated. Our patient has been recurrence free after an 18-month fol- low-up period. Discussion One of the concerns after RP is the occurrence of potentially recurrent UVA strictures. This complication Page 2 of 5 appears normally within a few months following surgery. Risk factors for the occurrence of strictures are previous bladder neck surgery, urinary extravasation and exces- sive intra-operative blood loss [6,7]. There are varying degrees of association of anastomotic contracture and stress urinary incontinence [8,9]. The AUS was intro- duced as a treatment for post-prostatectomy inconti- nence with excellent results [7]. One of the major, but unresolved, concerns of AUS placement is the time of implantation following the initial management of the stricture. A period ranging from six weeks to seven months has been reported [4,10]. Because no conclusion had been made, we decided to wait for six months before we placed the AUS. Unfortunately, even this interval was not enough. Thus, prospective studies are needed to establish the optimal interval. The management of a post-prostatectomy contracture has been performed with one-stage or two-stage proce- dures combining an aggressive incision of the stricture, followed by the AUS placement [4,5,7]. Others have suggested a transperineal urethroplasty combined with AUS implantation [11]. Although several treatment options such as dilatation, cold-knife incision, electro- cautery incision or resection of the stenotic bladder neck, Urolume stent placement, triamcinolone injection and use of the Ho:YAG laser have been proposed, the optimal management of UVA contracture has not been determined yet. Also, no prospective studies have been published. Yurkanin et al. [12] reported the achievement of good results by using cold- knife incision with a response rate of up to 87% after one session. A comparative study by Ramchandani et al. [13] however, reported that balloon dilatations were as effective as cold-knife incisions and suggested that cold-knife incisions should be left for complicated cases. In our case cold-knife incision Figure 1 Laser ablation of a stricture in the urethrovesical anastomosis.