The permanent Urolume Wallstent has been used for the relief of bladder outlet obstruction (BOO), detrusor-external sphincter dyssnergia (DESD), and recurrent bulbar urethral strictures. Because of its woven construction, it allows ingrowth of urothelial tissue, resulting in complete epithelialization by 6 to 12 months. Certain risk factors are associated with poor epithelialization that may lead to hyperplastic tissue growth and occlusion of the urethral lumen. We review the literature and discuss the 5-year results of the North American Multicenter Urolume Trial with regard to epithelialization, hyperplastic tissue growth, and treatment of hyperplastic growth.
The UroLume endoprosthesis has been used for recurrent bulbar urethral strictures, benign prostatic hyperplasia, and detrusor-external sphincter dyssynergia. Complications of the UroLume have been described by the North American Multicenter Trial as migration, encrustation, hyperplastic tissue growth, in addition to pain and irritative voiding symptoms. Generally, complications have been minimal, and few of the stents required removal. Patients with bulbar strictures were felt to be at relatively greater risk of hyperplastic tissue reaction if their stricture was secondary to trauma or if they had a prior urethroplasty. On the other hand, patients with benign prostatic hyperplasia were at risk of developing complications if they had median lobe enlargement or a short (<2.5 cm) prostatic urethra. We describe two cases in which off-label compassionate use of UroLumes in the anterior urethra and in an irradiated urethra led to adverse reactions such as stent separation, poor epithelialization, hyperplastic tissue growth, encrustation, or obstruction necessitating removal.
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