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Angulo JC, Kulkarni S, Pankaj J, Nikolavsky D, Suarez P, Belinky J, Virasoro R, DeLong J, Martins FE, Lumen N, Giudice C, Suárez OA, Menéndez N, Capiel L, López-Alvarado D, Ramirez EA, Venkatesan K, Husainat MM, Esquinas C, Arance I, Gómez R, Santucci R. Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience. Urology 2018; 118:213-219. [PMID: 29751026 DOI: 10.1016/j.urology.2018.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/22/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. MATERIAL AND METHODS This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. RESULTS Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P <.0001). Complications occurred in 8 (12.7%), all Clavien-Dindo ≤2. Disease-free survival rate after reconstruction was 88.1%, 79.5%, and 76.7% at 1, 3, and 5 years, respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (P = .018). CONCLUSION Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain.
| | | | - Joshi Pankaj
- Kulkarni Center for Reconstructive Urology, Pune, India
| | | | - Pedro Suarez
- Sección Cirugía Reconstructiva Uretral, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Javier Belinky
- Hospital General de Agudos Carlos G. Durand, Buenos Aires, Argentina
| | - Ramón Virasoro
- Eastern Virginia Medical School, Norfolk, VA; Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | - Carlos Giudice
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar A Suárez
- Hospital San José Tecnológico de Monterrey, Universidad de Monterrey, Nuevo León, Mexico
| | | | - Leandro Capiel
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | - Maha M Husainat
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI
| | - Cristina Esquinas
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | - Ignacio Arance
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | - Reynaldo Gómez
- Hospital del Trabajador, Universidad Andrés Bello, Santiago de Chile, Chile
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Abdallah MM, Selim M, Abdelbakey T. Thermo-expandable metallic urethral stents for managing recurrent bulbar urethral strictures: To use or not? Arab J Urol 2013; 11:85-90. [PMID: 26579252 PMCID: PMC4442926 DOI: 10.1016/j.aju.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess the role of temporary thermally expandable urethral stents in maintaining urethral patency in patients with a recurrent bulbar urethral stricture. Patients and methods Twenty-three men with a recurrent bulbar urethral stricture after several attempts at direct visual internal urethrotomy (DVIU) and/or failed urethroplasty were managed with a thermally expandable, biocompatible nickel–titanium alloy urethral stent (Memokath® MK044, Pnn Medical, Kvistgaard, Denmark). The stents were applied by a special mounting device via a rigid urethroscope after DVIU. All patients were followed using plain radiography, uroflowmetry and urine analysis every 3 months for 1 year, and then every 6 months. Results The mean (SD) age of the patients was 55.4 (7.3) years and the mean (SD) stricture length was 3.6 (1.2) cm. All patients tolerated the stent, with minimal discomfort in some patients. Four patients (17%) had urinary tract infections, three (13%) had haematuria, three (13%) had obstructed stents due to encrustation, in five (22%) the stent migrated, and two patients had no delayed complications. The mean (SD) follow-up was 17.4 (6.1) months. Conclusion Urethral stenting with nickel–titanium alloy thermally expandable stents can be an acceptable temporary procedure for patients with recurrent bulbar urethral strictures who are unfit for or who refuse urethroplasty. However, they have limitations; the search for an ideal urethral stent continues.
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Affiliation(s)
| | - Mohamed Selim
- Urology Department, Menoufiya University Hospital, Menoufiya, Egypt
| | - Tarek Abdelbakey
- Urology Department, Menoufiya University Hospital, Menoufiya, Egypt
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Palminteri E, Gacci M, Berdondini E, Poluzzi M, Franco G, Gentile V. Management of urethral stent failure for recurrent anterior urethral strictures. Eur Urol 2009; 57:615-21. [PMID: 20018439 DOI: 10.1016/j.eururo.2009.11.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. OBJECTIVE To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. DESIGN, SETTING, AND PARTICIPANTS We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. SURGICAL PROCEDURE The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. MEASUREMENTS Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. RESULTS AND LIMITATIONS Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. CONCLUSIONS The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive urethrostomy, or a permanent suprapubic diversion.
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Affiliation(s)
- Enzo Palminteri
- Centre for Reconstructive Urethral and Genitalia Surgery, Arezzo, Italy.
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Eisenberg ML, Elliott SP, McAninch JW. Management of restenosis after urethral stent placement. J Urol 2008; 179:991-5. [PMID: 18206915 DOI: 10.1016/j.juro.2007.10.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE We describe our experience with the management of restricture after urethral stent placement, including endoscopic and open surgical treatment. MATERIALS AND METHODS We surveyed our prospectively collected database for patients with restenosis after urethral stent insertion. We reviewed patient age, comorbidities, indications for stent placement, restricture length, management of restricture, postoperative complications and the further restenosis rate. RESULTS Overall we have treated 22 patients with failed urethral stents with a median followup of 30 months (range 1 to 96). All stents were initially placed for urethral stricture management. Stricture etiology included prostate cancer therapy in 9 cases, idiopathic causes in 6, urethral instrumentation in 2, trauma in 2, simple prostatectomy in 2 and gender reassignment/phalloplasty in 1. Ten patients had anterior urethral stricture, 11 had posterior stricture and 1 patient had each type. Of the 22 patients with stenosis after stent placement 13 underwent urethroplasty. Of the 18 patients with indwelling stents at treatment the stent was removed in 8 intraoperatively and in 10 the stent was left in situ. Ten of the 11 anterior strictures were treated with urethroplasty. Only 4 of the 12 posterior strictures were treated with urethroplasty, while 8 were managed endoscopically. Our overall success rate for treatment after stent failure was 67% (8 of 12 cases) for posterior urethral strictures and 82% (9 of 11) for anterior strictures. CONCLUSIONS Urethral stent failure requires complex intervention. A failed posterior urethral stent can often be managed endoscopically. Conversely we have managed failed anterior urethral stents by urethroplasty.
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Affiliation(s)
- Michael L Eisenberg
- University of California-San Francisco and San Francisco General Hospital, San Francisco, California 94110, USA
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