Transurethral resection of fibrotic scar tissue combined with temporary urethral stent placement for patients with in anterior urethral stricture

Abstract

_______________________________________________________________________________________Introduction: Fibrotic scar formation is a main cause of recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU). In the present study, we devised a new technique of combined the transurethral resection of fibrotic scar tissue and temporary urethral stenting, using a thermo-expandable urethral stent (Memokath TM 044TW) in patients with anterior urethral stricture. Materials and Methods: As a first step, multiple incisions were made around stricture site with cold-cutting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a Memokath TM 044TW stent (40 -60mm) on a pre-mounted sheath using 0° cystoscopy. Stents were removed within 12 months after initial placement. Results: We performed this technique on 11 consecutive patients with initial (n = 4) and recurrent (n = 7) anterior urethral stricture (April 2009 -February 2013. At 18.9 months of mean follow-up (12-34 months), mean Q max (7.8±3.9ml/sec vs 16.8 ± 4.8ml/sec, p < 0.001), IPSS (20.7 vs 12.5, p = 0.001 ), and QoL score (4.7 vs 2.2, p < 0.001) were significantly improved. There were no significant procedure-related complications except two cases of tissue ingrowth at the edge of stent, which were amenable by transurethral resection. In 7 patients, an average 1.4 times (1-5 times) of palliative urethral dilatation was carried out and no patients underwent open surgical urethroplasty during the follow-up period. Conclusion: Combined transurethral resection and temporary urethral stenting is a effective therapeutic option for anterior urethral stricture. Further investigations to determine the long-term effects, and safety profile of this new technique are warranted.

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

“…The Memokath, a thermos expandable stent, has been used particularly in spinal cord patients with detrusor sphincter dyssynergia and for bladder outlet obstruction. Yoon et al examined 12-month placement of Memokath stents for anterior urethral strictures, and while they reported it as an effective therapeutic option, the majority of patients required further dilatations and 18% required further transurethral resection (60). …”

Overexpressed miR‐486 in bone marrow mesenchymal stem cells represses urethral fibrosis and targets Col13a1 in urethral stricture rats

“…Fibrotic scar formation within the urethral lumen after injury is closely associated with the pathogenesis of US, especially recurrent US. 30 Several anti‐fibrotic drugs such as mitomycin C and halofuginone, have been used to limit the recurrence of US after endoscopic management; however, none of these agents exhibit sufficient efficacy after administration. 31 Thus, it is imperative to further understand the mechanism underlying the pathogenesis of US and find more effective therapeutic approaches for this disease.…”