Urolume in urethral stenosis: Italian Club of Minimally Invasive Urology experience

The use of self-expanding metallic urethral stents in the treatment of recurrent bulbar urethral strictures: long-term results

OBJECTIVE

To evaluate the effectiveness and long-term results of using a self-expanding metallic urethral stent (Urolumetrade mark, American Medical Systems, Minnetonka, MI, USA) to treat recurrent bulbar urethral strictures.

PATIENTS AND METHODS

Between 1990 and 1999, 65 stents were placed in 60 men (mean age 45.2 years, range 20-71) with a urethral stricture (mostly caused by trauma and present for a mean of 4.3 years, range 0.16-26) and who had previously undergone different unsuccessful treatments.

RESULTS

During a mean (range) follow-up of 3.8 (1-9) years the strictures in 52 of the 60 patients (87%) were treated successfully. All patients initially had postvoid dribbling incontinence, but this resolved in most within one week; 19 patients remain incontinent.

CONCLUSION

The Urolume is a cost-effective alternative to other treatments for recurrent bulbar urethral strictures of whatever cause.

Endoprosthesis implantation in the treatment of recurrent urethral stricture: a multicenter study. Sicilian-Calabrian Urology Society

PURPOSE

This study was conducted by nine urology departments in southern Italy to assess the efficacy of and tolerance to treatment of recurrent urethral stricture using a permanent prosthesis.

PATIENTS AND METHODS

Since 1992, 99 prostheses have been implanted to treat inflammatory and iatrogenic (seven departments) or all types (two departments) of urethral strictures. The Urolume Wallstent was used in 94 cases. Three centers implanted more than one prosthesis when this was indicated. Local anesthesia was used by six centers, spinal anesthesia by two, and local or general by one. At three centers, urethrotomy was performed immediately prior to implantation; two centers used dilation to 30F, and two centers performed urethrotomy 24 or 36 hours before implantation. The median follow-up is 29.1 months (range 3-53 months).

RESULTS

The results were good in 52%, fair in 34%, and poor in 14% of patients. The maximum flow rate increased >75% in 82% of patients. All departments reported complete reepithelialization of the urethra by 6 months. The short-term complications (7-28 days) were perineal discomfort (86%) and dribbling (14%). The long-term complications were painful erection (44%), mucous hyperplasia (44%), recurring stricture (29%), and incontinence (14%). All departments performed resection for hyperplasia in many cases.

CONCLUSION

Permanent urethral endoprostheses can produce excellent results in patients with recurrent urethral strictures.

Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful?

PURPOSE

We evaluate the efficacy of repeated dilation or urethrotomy as treatment of male urethral strictures.

MATERIALS AND METHODS

Between January 1991 and January 1994, 210 men with proved urethral strictures were prospectively randomized to undergo filiform dilation (106) or internal urethrotomy (104). Followup was scheduled at 3, 6, 9, 12, 24, 36 and 48 months. Dilation or internal urethrotomy was repeated at the first and second stricture recurrence. The Kaplan-Meier method was used to estimate survivor function for the treatment methods (survival time being the time to first stricture recurrence) and the log rank test was used to compare the efficacy of different treatments.

RESULTS

Followup (mean 24 months, range 2 to 63) was available in 163 patients (78%). After a single dilation or urethrotomy not followed by re-stricturing at 3 months, the estimated stricture-free rate was 55 to 60% at 24 months and 50 to 60% at 48 months. After a second dilation or urethrotomy for stricture recurrence at 3 months the stricture-free rate was 30 to 50% at 24 months and 0 to 40% at 48 months. After a third dilation or urethrotomy for stricture recurrence at 3 and 6 months the stricture-free rate at 24 months was 0 (p <0.0001).

CONCLUSIONS

Dilation and internal urethrotomy are useful in a select group (approximately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second dilation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotomy is of no value.