Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture

다국어 초록 (Multilingual Abstract)

Purpose: To report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents.
Materials and Methods: Between March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis.
Results: The mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months.
Conclusions: Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results.

참고문헌 (Reference)

1 최상훈, "부분 요도협착에서 Holmium Laser를 이용한 내시경하 내요도절개술의 초기 경험" 대한비뇨기과학회 50 (50): 246-250, 2009

2 Low AI, "Use of the Memokath for detrusor-sphincter dyssynergia after spinal cord injury: a cautionary tale" 36 : 39-44, 1998

3 Soni BM, "Use of Memokath, a second generation urethral stent for relief of urinary retention in male spinal cord injured patients" 32 : 480-488, 1994

4 Badlani GH, "Urolume endourethral prosthesis for the treatment of urethral stricture disease: long-term results of the North American Multicenter UroLume Trial" 45 : 846-856, 1995

5 Anger JT, "Urologic Diseases in America Project. Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty?" 77 : 481-485, 2011

6 Webster GD, "Urethroplasty management in 100 cases of urethral stricture: a rationale for procedure selection" 134 : 892-898, 1985

7 Andrich DE, "Urethral strictures and their surgical treatment" 86 : 571-580, 2000

8 Heyns CF, "Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful?" 160 : 356-358, 1998

9 Bhargava S, "Tissue-engineered buccal mucosa for substitution urethroplasty" 93 : 807-811, 2004

10 Abdallah MM, "Thermo-expandable metallic urethral stents for managing recurrent bulbar urethral strictures: to use or not?" 11 : 85-90, 2013

11 Perry MJ, "Thermo-expandable intraprostatic stents in bladder outlet obstruction: an 8-year study" 90 : 216-223, 2002

12 Hamid R, "The mesh wallstent in the treatment of detrusor external sphincter dyssynergia in men with spinal cord injury: a 12-year follow-up" 91 : 51-53, 2003

13 Fabian KM, "The intra-prostatic "partial catheter" (urological spiral) (author's transl)" 19 : 236-238, 1980

14 Eisenberg ML, "Preservation of lower urinary tract function in posterior urethral stenosis: selection of appropriate patients for urethral stents" 178 : 2456-2460, 2007

15 Lumen N, "Oosterlinck W. Etiology of urethral stricture disease in the 21st century" 182 : 983-987, 2009

16 Greenwell TJ, "Mundy AR. Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective" 172 : 275-277, 2004

17 Mehta SS, "Memokath stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: the Princess Royal Spinal Injuries Unit 10-year experience" 44 : 1-6, 2006

18 Santucci RA, "Male urethral stricture disease" 177 : 1667-1674, 2007

19 McFarlane IP, "Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia" 78 : 729-732, 1996

20 Steenkamp JW, "Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison" 157 : 98-101, 1997

21 Pansadoro V, "Internal urethrotomy in the management of anterior urethral strictures: long-term followup" 156 : 73-75, 1996

22 Jordan GH, "Effect of a temporary thermo-expandable stent on urethral patency after dilation or internal urethrotomy for recurrent bulbar urethral stricture: results from a 1-year randomized trial" 190 : 130-136, 2013

23 Chiou RK, "Changing concepts of urethral stricture management. I: Assessment of urethral stricture disease" 81 : 282-286, 1996

24 Bhargava S, "Buccal mucosal urethroplasty: is it the new gold standard?" 93 : 1191-1193, 2004

25 Bullock TL, "Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States" 177 : 685-690, 2007