European Experience with the Urethral Wallstent for Urethral Strictures

Ashken, M. Handley; Coulange, C.; Milroy, E. J. G.; Sarramon, Jean‐Pierre

doi:10.1159/000473615

Cited by 69 publications

(19 citation statements)

References 6 publications

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“…The recommendation is that the traumatic strictures should not be managed with the urolume Wallstent. 8 The urine stream of our patient deteriorated during follow-up, but he became stable and was satisfied with his urination. He has not needed urethral dilatation over the last three years.…”

Section: Discussionmentioning

confidence: 60%

“…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. [10][11][12] Various modifications in the material and shape of the stent have been made to make it more tissue compatible and easier to remove if the need arises.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Role of Wallstent® in Urethral Stricture

Kardar

Lindstedt

1998

Ann Saudi Med

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“…En la experiencia de Kessler et al el riesgo de fracaso de una UP fue 3,69 veces mayor en pacientes previamente tratados con endoprótesis que en aquellos sin implante previo de la misma 20 . Otras complicaciones no quirúrgicas incluyen goteo posmiccional significativo en el 32% e infecciones urinarias recurrentes en el 16% [33][34][35] . En la tabla 3 se detallan los resultados de 3 series con buen seguimiento, observando que el éxito final a largo plazo es igual o inferior al de la UIE.…”

Section: Endoprótesis Intrauretralesunclassified

Manejo racional y selectivo de los pacientes con estenosis de uretra anterior

2011

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PALABRAS CLAVEUretra; Estenosis uretral; Uretroplastia; Estrechez uretral; Uretrotomía interna ResumenIntroducción: el manejo de la estenosis de la uretra anterior es controvertido. Se lleva a cabo un artículo de revisión que pone al día el estado actual del tratamiento quirúrgico de la estenosis de uretra anterior. Material y métodos: se revisa la experiencia del Hospital del Trabajador en Santiago de Chile respecto a las diferentes modalidades de tratamiento quirúrgico para esta entidad y se revisa la literatura científica al respecto. Resultados: tradicionalmente la estenosis de uretra anterior se ha tratado con métodos míni-mamente invasivos (dilataciones y uretrotomía interna), que no son capaces de curar a más del 30-35% de los pacientes. Por otro lado la cirugía de reconstrucción uretral (uretroplastia) es más compleja y requiere entrenamiento, pero puede curar a la vasta mayoría de los pacientes en un solo procedimiento quirúrgico. Debido a falta de experiencia y entrenamiento en cirugía reconstructiva, existe sobreuso y abuso de los métodos no invasivos, en perjuicio de la calidad de vida de los pacientes. Existe amplia evidencia de que la uretrotomía interna es un excelente método para tratar estenosis de hasta 1 cm de longitud, pero su efectividad disminuye drásti-camente por encima de 1,5 cm. Ahora bien, las estenosis más largas tienen indicación directa de uretroplastia, sobre todo si ya ha fallado una uretrotomía previa. Conclusión: el manejo de este proceso debe ser selectivo, empleando el tratamiento apropiado orientado a curar y no sólo a paliar la enfermedad. Es necesario mejorar el entrenamiento de los urólogos en uretroplastia y/o establecer centros de referencia para poder ofrecer un tratamiento óptimo a cada caso.

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“…The mobility of the pendulous urethra makes it unsuitable for stenting. Studies reporting 90% success for stenting have short follow-up [46][47][48] . However, Milroy and Allen reported that 84% of their 50 patients had open urethral lumen 5 years after implantation 49 .…”

Section: Stentsmentioning

confidence: 99%

Current concepts in the management of anterior urethral strictures

Mungadi¹,

Mbibu²

2010

Nigerian Journal of Surgical Research

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Objectives: This review paper presents the current trends in the evaluation and treatment of anterior urethral strictures. Stricture disease is recorded as one of the oldest afflictions of mankind and even in the millennium; it is the one disease associated with rapid turn over in treatment options and continuous evolution of new options. The stricture is still a significant burden on the urologist workload right from initiation of treatment and follows up. It may be associated with significant morbidity and deteriorating quality of life and may be frustrating to treat. Current trends are to discover a long lasting satisfactory treatment suitable in most cases 'the gold standard'. Methods A review of current concepts in anatomy and the patho-physiologic mechanisms of the anterior stricture has been done. A structured literature search through a MEDLINE search was performed. New urethral substitutes have been compared to other techniques of urethroplasty as seen over the. last decade. Expert surgical consensus and opinion have been reviewed. Results The anterior urethral stricture is a consequence of major peri-urethral fibrosis and may be very complex if the inflammation is complicated or prolonged. It can be satisfactorily assessed by routine retrograde urethrography and endoscopic assessment for type and complexity. The urethral ultrasound appears to provide more information about the extent of fibrosis and the length of strictures. In review of recent experience, it has proven to be accurate convenient and a cheap complement to already established studies. Oral mucosa, rectal mucosa, bladder mucosa , dermal grafts, tunica vaginalis, tissue culture and synthetic polymers have all been applied over the last decade in the search for the suitable urethral substitute. The bucccal mucosa is outstanding among several options in the repair of the diseased anterior urethra as popularized by Barbagli. It appears to provide the solution for most situations in the anterior urethral stricture.. Conclusions:The Bucccal mucosal graft(BMG) may as well be the new 'gold standard' in the management of anterior urethral stricture .

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European Experience with the Urethral Wallstent for Urethral Strictures

Cited by 69 publications

References 6 publications

Role of Wallstent® in Urethral Stricture

Role of Wallstent® in Urethral Stricture

Manejo racional y selectivo de los pacientes con estenosis de uretra anterior

Current concepts in the management of anterior urethral strictures

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