Surgical Urethral Reconstruction After Failed Urethral Stents

Abstract

A definitive urethral reconstruction after permanent or temporary urethral stent explant is feasible and highly successful. Permanent urethral stents such as UroLume fell out of favor due to the high rate of long-term failure and complications. Although this type of a problem and a subsequent need for urethral reconstruction are becoming exceptionally rare, specialized urological reconstructive centers are still managing these complex patients with retained old stents. A definitive surgical solution must be individualized, but the best results are known to be associated with the preservation of the urethral segment by avoiding en-bloc removal of the diseased tissue encasing the stent. A longitudinal urethrotomy along the stented urethra and the stricture can be followed by a tine-by-tine removal of the wires that compose the stent. Once the stent pieces are removed, several forms of nontransecting urethral reconstruction can be performed using buccal mucosal grafts placed dorsolateraly, dorsaly or ventraly as onlays or/and inlays. Excision and primary anastomosis or augmented anastomotic urethroplasty are also reported to be viable options when urethral transection is performed. Other more complex techniques have been described, but are rarely needed. A recent multicenter experience confirmed a long-term success of urethroplasty after UroLume stent removal is 81% with significant improvements in flow rates and functional IPSS, while complication rate were only 12.7%. On the other hand, the experience with new temporary nitinol urethral stents is very limited. What is already established is that the temporary stents are not devoid of encrustation or recurrent stricture, and could also be successfully treated by definitive urethral reconstruction.