Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series

Sedigh, O.; Dalmasso, Ettore; Gobbo, Andrea; Dashti, M H; Bagheri, Fariborz; Shamsodini, Ahmad; Alqattan, Yaqoub; Soleimanzadeh, Farzin; Buffi, Nicolò Maria; Gontero, P.; Hosseini, Jalil

doi:10.1016/j.eururo.2023.05.019

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…In the context of previous literature on urethral stricture management, our study contributes valuable insights into the comparative efficacy and safety of HIU and CIU 26 , 27 . The findings align with historical preferences for these techniques, as CIU, introduced in the early 1970s, and HIU, described in the 1980s, continue to be widely utilized.…”

Section: Discussionmentioning

confidence: 87%

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Chi,

Lou,

Feng

et al. 2024

International Journal of Surgery

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Objective: Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). Methods: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. Results: Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD -0.06; 95% CI, -0.28–0.16; P=0.60, I2=75%) and mean surgical time (MD 2.16; 95% CI, -1.66–5.99; P=0.27, I2=98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI, 0.48–1.06; P=0.09, I2=46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI, 0.08–0.53; P=0.001, I2=0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD -2.51; 95% CI, -4.10–-0.91; P=0.002, I2=59%) and 12 months postoperatively (MD 2.62; 95% CI, 0.93–4.30; P=0.002, I2=0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI, 0.21–0.92; P=0.03, I2=0%). For short-segment urethral strictures with a length ≤1.5 cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI, 3.87–5.10; P<0.00001, I2=44%). Conclusion: Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time and recurrence rates. However, subanalysis indicates that in the short term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (≤1.5 cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding.

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Section: Discussionmentioning

confidence: 87%

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Chi,

Lou,

Feng

et al. 2024

International Journal of Surgery

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Prostatic stents: a narrative review of current evidence

Cerrato,

Antoniou,

Napolean Fernandes

et al. 2024

Therapeutic Advances in Urology

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Benign prostatic hyperplasia (BPH) is a common chronic urologic condition affecting approximately 50% of men above the age of 60. As per European Association of Urology Guidelines, BPH can be treated according to a stepwise approach starting from a conservative management, a pharmacologic approach, and finally surgery. Both medical and surgical therapies have side effects, impacting on ejaculation and sexual function and patients with multiple comorbidities might not be considered surgically suitable candidates. Prostatic stents offer a minimally invasive procedures in an out-patient setting, possibly under local anaesthesia. Utilized since the 1980s, the past stents encompassed permanent (epithelializing) or temporary (non-epithelializing) devices, like the Uro-Lume (American Medical Systems, Minnetonka, MN, USA) and the Memokath, or Memotherm (Engineers & Doctors A/S, Denmark), and the biodegradable stents made of self-reinforced poly-L-lactide or braided poly lactic-co-glycolic acid. Previous stents however showed a quite high rate of complications among which pain, incontinence, infections, stent migration or blockage, and incomplete degradation that might lead to premature removal of stent. The stents currently available on the market instead are the temporary device Allium Triangular Prostatic Urethral Stent (Allium Urological Solutions, Caesarea, Israel) and the temporary stent SPANNER (AbbeyMoor Medical, Inc., Parkers Prairie, MN, USA), which might be used in case of bladder outflow obstruction, post-operatively, or for acute urinary retention. Studies showed encouraging results, in terms of effectiveness and safety improving patients’ quality of life and International Prostate Symptom Score, but longer-term studies are needed to identify the most suitable patients who might benefit from their use. Newer stents and nitinol devices are currently investigated, and we are waiting for the results of the ongoing clinical trials.

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Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series

Cited by 2 publications

References 15 publications

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Prostatic stents: a narrative review of current evidence

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