A New Treatment for Urethral Strictures

Milroy, E. J. G.; Chapple, Christopher R.; Cooper, JE; El-Din, Ahmed B. Shehab; Wallsten, H; Seddon, Andrew M.; Rowles, P M

doi:10.1016/s0022-5347(17)42161-6

Cited by 19 publications

(23 citation statements)

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“…14 Centrally acting pharmacological therapy is ineffective for DSD 15 and agents such as dantrolene and baclofen not only have little effect but also potentially serious side effects (eg, fatal hepatotoxicity). 16,17 The use of endoluminal permanent wire mesh stents (UroLume s ) was first reported by Milroy et al, 18 in the treatment of bulbar urethral strictures. A 12-year review of wall stents for DSD in 12 patients by Hamid et al, 19 found them to be an effective alternative to sphincterotomy; however, in some, subsequent bladder neck dyssynergia emerged requiring further intervention.…”

Section: Discussionmentioning

confidence: 99%

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

Mehta

Tophill

2005

Spinal Cord

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thermosensitive stent as a 'nondestructive' means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury. Setting: Spinal Injuries Unit, Sheffield, England. Methods: A medical records review was performed to examine our experience of Memokaths over the last 10 years. During this time, 29 patients with spinal cord injury (17 tetraplegic and 12 paraplegic) underwent stenting of the external urethral sphincter either for prevention of dysreflexic symptoms, high residual urine volumes and subsequent urinary tract infection (UTI) or for protection of the upper tracts. Results: A total of 33 stents were inserted into 29 men (25-77 years) with suprasacral spinal cord injury. Initial results showed that the Memokath was effective in almost all for relief of dysreflexic symptoms and elimination of DSD on pressure flow urodynamics. However, to date, 30 of the 33 stents have been removed. The overall mean working life of the Memokath was 21 months. Four stents were removed electively and 23 for complications, which included stent migration (seven) and blockage (14). Single-ended stents were more prone to migration, which was rare after 1 year (1-13 months, median 3 months, mean 5.5 months). Stent blockage by encrustation or prostatic ingrowth did not occur before 12 months (12-45 months, median 30, mean 27.9 months). Conclusions: In selected patients, temporary, thermo-expandable (Memokath) stents are effective in the treatment of DSD. The 'working life' of a Memokath stent is 21 months; however, complications do occur which may necessitate removal. Our overall experience with Memokath stents was disappointing. In future, Memokath stents will only be inserted after careful consideration in patients with prior 'failed' transurethral sphincterotomy or with caution in patients suitable for reconstructive surgery.

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Section: Discussionmentioning

confidence: 99%

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

Mehta

Tophill

2005

Spinal Cord

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“…5 Intraluminal stents have been used since 1969 to prevent stenosis after balloon angioplasty. 6,7 The use of urethral stents to prevent recurrence of urethral strictures was first reported by Miller et al, 4 and was later tried in a number of European urological units. 8,9 There has been recent enthusiasm about the use of urethral stents in the recurrent urethral strictures, giving good short-term results.…”

Section: Discussionmentioning

confidence: 99%

Role of Wallstent® in Urethral Stricture

Kardar

Lindstedt

1998

Ann Saudi Med

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Urethral stricture is still a difficult urological disease entity to cure. Commonly used methods of urethral dilatation and optical urethrotomy are associated with a significant recurrence rate.1 Urethroplasty is usually successful in the treatment of many types of urethral stricture, 2 but the results are not so encouraging in iatrogenic and postinfection strictures.3 As a more conservative approach to recurrent stricture disease, a self-expandable stainless steel stent first used in cardiovascular systems has been used successfully for strictures of the urethra. 4 We report our experience with the urethral stent in eight patients. Materials and MethodsOver a four-year period, eight men with recurrent urethral stricture disease were treated with a urethral Wallstent (Medivent SA, Lausanne, Switzerland, supplied by American Medical Systems). The clinical features of each patient are detailed in Table 1. Their age ranged from 24 to 67 years (mean = 46). All the strictures had been treated by various methods. The stricture was located in the bulbar urethra in six patients who had been treated with multiple dilatations and optical urethrotomy. One of the patients had a stricture in the supramembranous urethra, secondary to a pelvic fracture sustained in a road traffic accident. This patient had had urethroplasty twice previously. Another patient had developed detrusor-sphincter dyssynergia (DSD) as a result of cervical spinal cord injury in a road traffic accident. The length of stricture was from 1 cm to 3 cm, while the patient with DSD had a functional stricture of the whole posterior urethra. The maximum preoperative flow rate ranged from 0 mL to 8 mL per sec. (mean=3), as shown in Table 2. One of the patients with bulbar urethral stricture was passing urine in drops with no recordable flow, and the same was the case in the patient with the urethral stricture after pelvic fracture.The etiology of the strictures was infection in three cases, transurethral resection of the prostate in one, pelvic fracture in one, and DSD in one. The cause of stricture was unknown in two patients who had been having voiding problems since childhood.We used an endoscopic applicator for introduction of the stent in all cases. The length of the stent was 2 cm in two patients and 3 cm in three patients. Three patients required more than one stent overlapping each other, either because of the length of the stricture or initial placement of an undersized stent. The patients were followed at threemonth intervals. Flow rates were checked regularly, ascending urethrogram ( Figures 1A and B) and urethroscopy were performed when flow rate started to deteriorate. ResultsThe follow-up period ranged from 15 to 74 months (mean 48.1). Five patients (62.5%) were able to micturate well with satisfactory flow rates (Table 2) and without a need for further procedures. These included the patient with DSD who had been unable to empty his bladder after three internal sphincterotomies. Two patients developed recurrent stricture distal to the stent, which ...

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“…The device has been placed in the penile urethra of four mongrel dogs [5], and scanning electron microscopy after sacrifice at 2, 4, 6, and 1 2 months revealed no abnormalities in the deeper tissues of the urethra.…”

Section: Case Reportmentioning

confidence: 97%