Urethral reconstruction in patients with urethral stent failure: An international multicenter experience

Abstract

Introduction & Objectives: Treatment of urethral stricture using the Urolume™ urethral stent (American Medical Systems, Minnesota) was approved by the Food and Drug Administration in 1988 and distributed in many countries until 2011. Memokath™ (Pnn Medical, Denmark) is a thermo-expandable biocompatible endoprosthesis made of nitinol that is currently used for recurrent bulbar urethral stricture. This study evaluates the role and success rate of urethral reconstruction in patients with urethral stent and recurrent stricture. Materials & Methods: A retrospective multicenter study was conducted among different institutions with highvolume urethral reconstruction using a board-approved database. Factors analyzed included: stricture and stent length, time between stent and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline and post-urethroplasty voiding parameters. Successful outcome was defined as standard voiding, without need of any postoperative procedure. Results: Fifty-six patients were included. Stent was removed at the time of urethroplasty in 54 patients (4 endoscopically, 28 full-segment excision and 22 longitudinal section and explant of individual strands). Technique elected was: Excision and primary anastomosis 13 (23.2%), dorsal onlay buccal mucosa graft (BMG) 8 (14.3%), ventral onlay BMG 6 (10.7%), Kulkarni dorso-lateral onlay BMG 8 (14.3%), ventral onlay plus dorsal inlay BMG 2 (3.6%), augmented anastomosis 5 (8.9%), pedicled flap urethroplasty 5 (8.9%), 2-stage procedure 4 (7.1%) and perineal urethrostomy 5 (8.9%). Success rate was 80.4%. Dilatation and/or internal urethrotomy was performed in 10 (17.9%) and redo-urethroplasty in 5 (8.9%). Total IPSS, QoL, Qmax and PVR significantly improved (p<.0001). Complications occurred in 7 (12.5%), all Clavien-Dindo. Conclusions: Urethroplasty after re-stricture in patients with urethral stents is a viable option of reconstruction with a high success rate and few complications. Different techniques appear acceptable and decision mainly depends on the characteristics of the individual patient.