Long-term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis

Abstract

Urological Survey 794Others have pushed for early catheter removal but have admitted a higher chance of urinary extravasation.I think what is clear from this article is that surgeons have a choice -they can leave the catheter in for a long period of time and not perform imaging or they can try to remove the catheter early but should perform imaging if they do so. With prolonged catheterization comes increased risk of urinary tract infection and patient discomfort. With early catheter removal comes the risk that about 1 in 5 will need the catheter replaced for another week or two due to extravasation on imaging. It would seem that for patients who live close to a reconstructive center, early catheter removal with imaging and a chance of catheter replacement may be preferable. For those who live far from their reconstructive surgeon or who want to minimize extra visits, a longer period of catheterization without subsequent imaging would be appropriate. Study Type -Therapy (case series) Level of Evidence4 What's known on the subject? and What does the study add? Milroy reported 84% success at a mean of 4.5 years follow-up by usage of a permanently implantable "urolume" spent in 1993. Study Type -Therapy (case series) Level of Evidence Memotherm was developed later, especially for urologic use. Our study is one of the largest in this urea, with a high number of patients and a long follow-up period. Objective: To evaluate the effectiveness and long-term results of permanent urethral stent (Memotherm) implantation in the treatment of recurrent bulbar urethral stricture. Patients and Methods: In all, 47 patients with a history of previous unsuccessful treatment for bulbar urethral stricture were treated using Memotherm bulbar urethral stents between 1998 and 2002. Long-term follow-up data was analysed and discussed.Results: At the end of the 7-year period 37 of 47 patients (78.7%) had been treated successfully. Post-micturition dribbling incontinence lasting up to 3 months after stent placement occurred in 32 (68.1%) patients, but this was reduced to only seven patients (14.9%) by the 7-year follow-up. There was stress incontinence of various severities in nine (19.2%) patients at the 1-year follow-up. These patients were those who had stenosed urethral segments adjacent to the external sphincter. At the long-term follow-up < 10% of the patients had stress incontinence complaints. Conclusion: Memotherm is a good treatment option in patients with recurrent bulbar urethral stricture of any cause.

Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures

“…No stent migration has been observed in these 18 patients. In contrast with the previous studies, none of our patients presented with partial migration after the surgical procedure has been changed (3,7,8). We think that stent implantation should be performed at least 2 weeks following the internal urethrotomy procedure to achieve optimal epithelization.…”

“…In the present study eight patients reported discomfort in the implantation area in the first postoperative month and the patients were treated with alpha-blocker and anti-inflammatory drugs. In contrast with the previous studies, none of our patients experienced the extraction of the stent due to discomfort in the implantation area (3).…”

“…In reviewing the literature, this may be due to post-voiding of urine accumulated in the stent (8). The rate of dripping after micturition decreased after stent epithelization in the long-term follow-up (3).…”