One-Stage Urethral Reconstruction For Stricture Recurrence After Urethral Stent Placement

Main Category: Urology / Nephrology
Also Included In: Medical Devices / Diagnostics
Article Date: 16 Apr 2007 - 0:00 PDT

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UroToday.com- The Urolume endoprosthesis was developed to provide a simple treatment option for recurrent bulbar stricture disease. It consists of a self-expanding superalloy braided wire mesh cylinder that is placed endoscopically. Despite initial good results and enthusiasm with this device, long-term results have been very poor and dealing with failures of this device can be very challenging. Simply "coring-out" the stent endourologically can help establish urethral patentcy but rarely gives a durable result.

A recent report by J. Gelman and E. Rodriguez from UC Irvine Medical Center describes the technique and results of 10 men who underwent single-stage reconstruction of recurrent strictures within a Urolume stent. The report is published in the January 2007 issue of the Journal of Urology.

All patients underwent pre-operative evaluation with a retrograde urethrogram (RUG) and a voiding cystourethrogram (VCUG) and urethroscopy. Seven of the 10 patients had their stents in place at the time of definitive reconstruction while 3 had had endoscopic removal of their stents prior to urethroplasty. The patients were placed in an exaggerated lithotomy position via a perineal approach. Anastomotic urethroplasties were performed for strictures of the bulbar or bulbomembranous urethra when possible. This included 2 patients with bulbar strictures and all 3 patients with traumatic posterior strictures. The remaining 5 patients had longer strictures precluding primary anastomosis and required tissue transfer. The first patient was treated with a penile flap while the next 4 underwent dorsal onlay buccal mucosa urethroplasties. In cases where the stent had to be excised, the urethra was mobilized and the ventral side was anastomosed and a dorsal onlay buccal mucosa urethroplasty was performed. One patient had 5 cm of urethral loss and needed to be repaired with both a dorsal and a ventral onlay buccal graft for circumferential replacement. Suprapubic tubes and 14 Fr urethral catheters were maintained for 3 weeks.

Follow-up consisted of urinary flow rates, post-void residual determination, and AUA symptom scores. Repeat urethroscopy was performed if recurrence was suspected. At a median follow-up of 51 months, all patients have remained free of recurrence of strictures. No patient required dilation, catheterization, or other intervention. This high rate of success is somewhat surprising considering this patient population but the authors should be commended on their outcomes.

Gelman J, Rodriguez Jr. E

J Urol. 2007 Jan; 177(1):188-191
Reviewed by UroToday.com Contributing Editor Michael J. Metro, MD

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