Urethral Stent Placement Research Articles

Artificial urinary sphincter and stricture disease: surgical principles in management.

Iatrogenic stress urinary incontinence (SUI) is the most common complication of surgical treatment of prostate cancer, regardless of operative approach, and has a major impact on patients' quality of life. Although SUI can occur after surgical treatment of benign prostatic hyperplasia, specifically transurethral prostate resection, laser enucleation of the prostate, and simple open prostatectomy, these therapeutic modalities play a much less significant role in the etiology of SUI. Artificial urethral sphincter (AUS) implantation is considered the standard treatment modality providing high success rates, including durable efficacy, and optimal patient satisfaction for moderate to severe urinary incontinence resulting mainly from radical prostatectomy. However, although complication rates are generally acceptably low, revision and/or explantation may be required due to mechanical failure and non-mechanical problems, specifically urethral atrophy/cuff deficient occlusion, infection, and cuff erosion. Several risk factors for AUS failure associated with a fragile, compromised urethra have been identified and these play a critical role in device cuff erosion and subsequent removal of the device. Among others, apparently the most impacting factors are irradiation, urethral stent placement, a previous AUS placement, and importantly presence of urethral stricture or prior urethroplasty. Generally, any clinical situation leading to a diseased urethra or lack of urethral integrity is associated with impaired local blood perfusion, and consequently lower success rates. The present review aims to evaluate the impact of the presence of prior urethral strictures and urethroplasty on the outcomes of AUS implantation on one hand, and vice-versa, the influence of AUS placement on later urethral stricture surgery, particularly following cuff erosion.

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

BackgroundRecent years have seen the development of a new generation of temporary urethral stents as an adjuvant option after direct vision internal urethrotomy (DVIU). Despite some early promising results, large series addressing their safety and outcomes are still lacking. ObjectiveTo report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. Design, setting, and participantsWe performed a retrospective analysis of bulbar urethral stenting procedures after DVIU in seven centers. Patients either refused urethroplasty or were not fit for surgery. The stents were removed after at least 6 mo in place unless complications requiring earlier removal occurred. Surgical procedureDVIU with a cold knife or laser is performed, followed by stent placement. At the end of the treatment period, the stent is removed under cystoscopy with gripping forceps. MeasurementsAll patients underwent postoperative follow-up (FU) for assessment of complications while the stent was in place. After removal, the FU schedule consisted of office evaluation at 6 mo and 12 mo, and then annually. Failure was defined as any treatment for urethral stricture after stent removal. Results and limitationsA total of 49% of the patients experienced complications. The most frequent were discomfort (23.8%), stress incontinence (17.5%), and stent dislocation (9.8%). Some 85% of the adverse events observed were Clavien-Dindo grade <3. The overall success rate at median FU of 38.2 mo was 76.9%. The success rate was significantly lower if the stent was removed before 6 mo (53.3% vs 79.7%; p = 0.026). ConclusionsTemporary urethral stents may be a safe choice with satisfactory results in patients not undergoing urethroplasty. A stent indwelling time shorter than 6 mo provides worse outcomes that are comparable to those with DVIU alone. Patient summaryWe assessed complications and outcomes after placement of a temporary narrow tube in the urethra after surgery to widen a narrowing of the urethra. The treatment is safe and easily reproducible with satisfactory results. Further studies are needed to confirm our findings.

Epidemiology and risk factors for febrile ureteral stent-associated urinary tract infections: A prospective observational cohort study

We aimed to determine the incidence and risk factors of febrile ureteral stent-associated urinary tract infections (FUSAUTI). Hospitalized adult patients with ureteral stent (US) placement or exchange were prospectively enrolled. Patients with kidney transplantation of less than one year were excluded. Patients were followed until US removal/exchange or six months after inclusion. Out of 663 patients included in the study, 48 had at least one FUSAUTI (cumulative incidence 7.24%; 95% confidence interval [CI] 5.39-9.48). The incidence rate of FUSAUTI was 9.04 (95% CI 6.67-12.2) per 10,000 US-days. Ten patients (20.8%) experienced sepsis or septic shock. The most frequently isolated microorganisms were Escherichia coli (38%), Enterococcus spp. (14.5%), Candida spp. (9%) and Pseudomonas aeruginosa (9%). In multivariable logistic regression analysis, female gender, an age adjusted Charlson comorbidity index score>3, an urethral stent placement concomitant with US placement, and a history of urinary tract infection within three months were significantly associated with a higher risk of FUSAUTI. After US placement, 7.24% of patients developed at least one FUSAUTI and, in a quarter of cases, a serious infection. Urethral stent placement was the only modifiable risk factor identified. Future interventional studies are needed to reduce FUSAUTI in these patients.

Assessment of Wound Healing Following Collagen Urethral Stent Placement for Urethrotomy in Dogs

Background: The present study was undertaken to evaluate the efficiency of collagen urethral stents on wound healing post-urethrotomy in dogs and to assess the uptake of collagen urethral stents through urethrography, ultrasonography and hematobiochemical analysis. Methods: A total of 12 dogs presented to Madras Veterinary College teaching hospital with the history of urinary obstruction were chosen for the study and were randomly divided into 2 groups of 6 dogs in each. In Group I, dogs were treated with conventional urethrotomy procedure and in group II, animals were treated with urethrotomy with collagen urethral stent placement. Hematobiochemical, plain and contrast radiography, ultrasonograhy were performed in both the groups. Result: The study revealed that in comparison with Group I, Group II animals had a faster wound healing rates; reduction in urethral lumen diameter and urethral leakage post-operatively were not observed in both the groups. In the present study, ultrasound was used to identify and locate the calculi but also to check the collapse, migration and absorption of the collagen stent placed inside the urethra wherein no stent collapse or migration noticed. Partial collagen stent absorption was noticed on day 7 and a complete stent absorption was noticed on day 14. There was no significant difference in the pain scores between the groups indicating that the collagen stent does not elicit any extra pain as compared to normal urethrotomy procedure.

Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures

This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.

Use of Temporary Membrane-Covered Self-Expandable Metallic Stent - UVENTATM for Treatment of Recurrent Bulbar Urethral Stricture.

IntroductionRecurrent urethral stricture is a real challenge. Interestingly use of temporary double layered self-expanding nitinol urethral stent with polytetrafluoroethylene (PTFE) membrane coating (UventaTM, Taewoong Medical, South Korea) has been recently reported with promising short-term results in recurrent urethral stricture. However most of the reported studies are published as abstracts of either case reports or case series of miniscule numbers. The aim of our study is to evaluate the outcome of this temporary urethral stent in patients with recurrent urethral stricture after urethroplasty as well as after multiple visual internal urethrotomy.Materials and MethodsIn this retrospective study, 22 patients had placement of double-layered self-expanding stent with PTFE membrane coating (Uventa, Taewoong Medical) for recurrent bulbar strictures. The present study included cases between 2017 and 2020. The stricture in each patient were evaluated with Uroflowmetry and ascending urethrography. The data of demographic and clinical characteristics included age, aetiology, location and length of stricture, along with maximum urinary flow rate (Qmax), number of previous interventions, and stent-related complications.ResultsThe overall clinical success was achieved in 13/22 (59.1%) of patients at a median follow-up of 17 months (range 2–44). The mean maximum urine flow rates were 7.07 ± 3.55mL/sec, 23.50 ± 10.41mL/sec, 21.41± 15.55 mL/sec, 14.88 ± 9.77 and 17.63 ± 12.28 mL/sec before, while stent in place, at 3 months, 6 months and 12 months after the procedure, respectively. ConclusionIn our study, the success rate of temporary urethral stent placement has remained at 59.1% at a median follow-up of 17 months. We conclude that further randomized controlled studies with long-term follow up are required to fully evaluate the outcome.

Evaluation of Temporary Urethral Stents in the Management of Malignant and Nonmalignant Urethral Diseases in Dogs.

Urethral stent placement is a minimally invasive interventional procedure commonly performed by specialists to alleviate urethral obstruction. However, the availability of urethral stents is limited by their high cost and the need for special equipment. The aim of this retrospective study was to describe the construction and placement of an inexpensive temporary urethral stent and to report on its outcome in managing dogs with naturally occurring urethral disease. Temporary stents were placed in the urethra of 17 dogs with malignant and nonmalignant urethral pathologies. The most common indication for temporary stent placement was urethral obstruction. In this population, urethral patency was restored in all dogs. The most frequently reported complication was urinary incontinence. To manage this complication, dogs were diapered. Temporary urethral stents served as a durable and inexpensive alternative to expanding metallic stents. Because temporary stents were constructed from readily available materials and inserted without special equipment, practitioners capable of catheterizing the urethra can insert them on demand.

Temporary penile urethral stent placement procedure as a treatment of penile urethral obstruction in Intact Tom Cats.

Temporary penile urethral stent placement procedure as a treatment of penile urethral obstruction in Intact Tom Cats.

Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success

Introduction: After implantation of an artificial urinary sphincter (AUS) due to stress urinary incontinence, in some cases revision procedures may be necessary. This is mostly due to device infection or cuff erosion in the long term. The aim of this study was to evaluate the impact of early revision procedures (prior to or immediately after AUS activation) on the long-term outcome. Methods: We retrospectively evaluated patients who underwent primary AUS implantation between 2006 and 2019. Patients with previous radiotherapy, urethroplasty, urethral stent placement, or repeat AUS implantation were excluded. Early revision was defined as prior to or immediately after AUS activation and comprised pump repositioning or cuff size adaptation due to difficulties in using the pump, persistent urinary incontinence, or urinary retention. Patients were compared with regard to complication rates, functional outcome, and patient satisfaction. Univariable and multivariable logistic regression analyses were performed to analyze risk factors for early AUS revision. Kaplan-Meier analysis evaluated explantation-free survival. Results: A total of 250 patients were included. Twenty patients (8%) required early revision (pump repositioning in 15 cases [75%], cuff downsizing in 3 cases [15%], and cuff upsizing in 2 cases [10%]). Mean follow-up was 78.6 months. 96.4% of all patients were objectively continent at the time of last follow-up without differences between both groups, and patient satisfaction was high in both groups. No differences with regard to mechanical implant failure, tissue atrophy, and AUS explantation due to cuff erosion or implant infection were observed. Explantation-free survival was comparable in both groups. On univariable logistic regression analysis, coronary artery disease and transcorporal cuff placement were associated with early AUS revision. Conclusion: Early revision after AUS implantation can be performed without negative impact on the long-term outcome.

Surgical repair and subsequent stent placement following traumatic trans‐rectal urethral transection in a dog

AbstractA one‐year‐old male castrated Australian Shepherd presented for rectal trauma after falling into bushes. A 10‐cm long segment of tissue protruded from the anus, and there were no other visible injuries. Abdominal radiographs showed intrapelvic and perirectal subcutaneous emphysema extending into fascial planes of the right hindlimb. Exploratory surgery was performed, and the tissue protruding out of the anus was identified as proximal urethra extending through a 6 cm longitudinal tear in the ventral rectal wall. Urethral debridement and anastomosis were performed, and the rectal wall repaired. A urinary catheter was in place for 5 days postoperatively. The patient had intermittent episodes of stranguria and pollakiuria and multi‐drug resistant urinary tract infection (Enterococcus faecium) cultured. A pelvic urethral stricture was diagnosed on contrast cystourethrogram, and a nitinol stent placed under fluoroscopic guidance. Sporadic haematuria was observed, which was resolving in a few months. Urethral stent placement provided successful long‐term outcome.

Orthostatic hypotension secondary to a suspected thymoma in a dog: a case report

BackgroundThis is the first case report description, to our knowledge, of a cranial mediastinal mass (suspected thymoma) causing orthostatic hypotension in a dog.Case presentationA Labrador Retriever presented for urethral stent placement during cystoscopy secondary to transitional cell carcinoma diagnosis. During anesthesia, the patient had unexpected severe and poorly-responsive hypotension following a shift in position. Several days later, an intrathoracic mass was discovered, raising concerns that the position of the mass in relation to the great vessels and heart may have been the cause of the hypotension. The patient returned for a second stent placement, and computed tomography of the chest confirmed a cranial mediastinal mass, most suspected to be thymoma based on the results of cytology. The patient was kept in sternal recumbency, but when re-positioning to left lateral recumbency, there was a dramatic blood pressure drop that corrected with a return to sternal positioning.ConclusionsTo our knowledge, orthostatic hypotension has not been described in relation to thymoma in dogs. Thymomas are rare; however, they may be associated with disease of autonomic dysfunction, such as myasthenia gravis, that may lead to orthostatic hypotension. This has been described within the human literature, and we hypothesize it was present in the currently described case. Concurrently, thymomas may grow to a substantial size and cause direct compression of the intrathoracic vasculature. As such, it should be on the differential list for poorly-responsive hypotension following a shift in body positioning under anesthesia.

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety.

We aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment. This is a retrospective cohort study examining patients with recurrent VUAS post-radical prostatectomy (RP) ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o'clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o'clock incision sites. Treatment outcomes were determined with cystoscopy. Eighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61-68); median time to VUAS from RP was eight months (IQR 5-12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3-10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection. Triamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.

Novel Treatment Strategy for Management of Traumatic Bulbar Urethral Rupture Using Temporary Urethral Stent after Primary Realignment; Retrospective Comparison between Thermo-Expandable Urethral Stent and Self-Expandable Polymer-Coated Urethral Stent.

A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.

Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation.

To evaluate the impact of previous urethroplasty on complication rates and postoperative continence after primary artificial urinary sphincter (AUS) implantation in male patients with severe stress urinary incontinence. A prospective evaluation of patients undergoing primary AUS implantation was conducted. Patients with previous radiotherapy, AUS implantation or urethral stent placement were excluded. Main endpoints were postoperative continence and complication rates including necessity of AUS explantation. Kaplan-Meier analysis evaluated explantation-free survival. Logistic regression analyses were performed to identify potential predictors for AUS explantation. 105 patients were included with a mean follow-up of 76.6months (SD 15.9). 30 of these patients had a history of urethroplasty. Postoperatively, 96.2% of all patients were objectively continent (≤ 1 pad/day). No differences in postoperative continence and early complication rates were observed. Concerning long-term complications, infection, mechanical implant failure, and tissue atrophy were also comparable. Overall sphincter erosion rate was 12.3%, but significantly higher in urethroplasty patients (23.3% vs. 8.0%, p = 0.038) and sphincter explantation rate was threefold higher (p = 0.016) in the urethroplasty group. Furthermore, explantation-free survival was reduced compared to the non-urethroplasty group (p = 0.044). On logistic regression analysis, the previous urethroplasty was the only significant predictor for AUS explantation (p = 0.016). AUS implantation in patients with former urethroplasty can provide satisfying results. Compared to patients without the previous urethroplasty, the higher risk of cuff erosion and AUS explantation has to be addressed during preoperative consultation. Patients with the previous urethroplasty with grafting, long strictures and previous visual internal urethrotomy might be at highest risk.

The maximum detrusor pressure as a predictive factor of success after sphincterotomy in detrusor-sphincter dyssynergia.

To evaluate the impact of the pre-operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation by sphincterotomy or urethral stent placement in male patients with neurogenic detrusor-sphincter dyssynergia (DSD). A retrospective study was performed in 41 male patients treated between 2006 and 2013 in a tertiary reference center. All patients had a neurogenic DSD confirmed by baseline urodynamic studies, and were unable or secondary failed to practice CISC. Success was defined as a post-void residual volume <150 mL. Influence of MDP on treatment efficacy was evaluated through a Mann-Whitney U-Test. Median (range) age was 39 years (20-69). Spinal cord injury was the main underlying condition. Twenty-six patients had a sphincteric stent placement (Memocath®, Bard, Covington) and 15 had surgical sphincterotomy. Treatment was successful in 31 patients (76%). Patients with immediate successful outcomes had a significantly higher mean preoperative MDP (59.6 vs 29.7 cmH2 O; P = 0.002). Patients with MDP over the threshold of 40 cmH2 O had a 90% success rate. These differences were maintained at 6 months, MDP being higher in the success group than in the failure group (59.5 vs 39.8 cmH2 O, respectively, P = 0.008). The technique used (stent placement or incision) had no impact on immediate or 6-month success rates. Our results suggested that MDP is associated with treatment success rate after surgical management of DSD of neurogenic origin by sphincteric stent placement or surgical sphincterotomy. A threshold of 40 mH2 O is associated with higher success rates.

Submucosal Collagen Injection for Management of Urinary Incontinence Following Urethral Stent Placement

An 8-year-old, entire, male British Bulldog was referred for a week-long history of severe stranguria and dysuria. A prostatic wash was diagnostic of prostatic carcinoma. A transluminal urethral stent was placed in the proximal urethra, which resulted in resolution of the urinary obstruction, however, the dog developed severe urinary incontinence after the procedure. Cystoscopically-guided submucosal collagen injections were performed immediately proximal to the os penis. The dog's incontinence resolved with a single collagen injection for the 10-month follow-up period.

Urethral Stenting for Obstructive Uropathy Utilizing Digital Radiography for Guidance: Feasibility and Clinical Outcome in 26 Dogs.

BackgroundUrethral stent placement is an interventional treatment option to alleviate urethral outflow obstruction. It has been described utilizing fluoroscopy, but fluoroscopy is not as readily available in private practice as digital radiography.ObjectivesTo describe the use of digital radiography for urethral stent placement in dogs with obstructive uropathy.AnimalsTwenty‐six client‐owned dogs presented for dysuria associated with benign and malignant causes of obstructive uropathy that underwent urethral stent placement.MethodsRetrospective study.ResultsCauses of obstructive uropathy included transitional cell carcinoma, prostatic carcinoma, hemangiosarcoma, obstructive proliferative urethritis, compressive vaginal leiomyosarcoma, and detrusor‐sphincter dyssynergia. Survival time range was 1–48 months (median, 5 months). All dogs were discharged from the hospital with urine outflow restored. Intraprocedural complications included guide wire penetration of the urethral wall in 1 dog and improper stent placement in a second dog. Both complications were successfully managed at the time of the procedure with no follow‐up problems noted in either patient.Conclusion and Clinical ImportanceUrethral stent placement can be successfully performed utilizing digital radiography. The complications experienced can be avoided by more cautious progression with each step through the procedure and serial radiography. The application of digital radiography may allow treatment of urethral obstruction to become more readily available.

MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY Christopher Powell, Travis Dum, William Brant, and Joshua Broghammer Christopher PowellChristopher Powell More articles by this author , Travis DumTravis Dum More articles by this author , William BrantWilliam Brant More articles by this author , and Joshua BroghammerJoshua Broghammer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing artificial urinary sphincter (AUS) following urethroplasty are often categorized as high-risk due to previous urethral instrumentation and theoretical altered urethral vascular supply. Limited data exist regarding outcomes in these patients making appropriate patient counseling difficult at best. We compare outcomes of AUS placement at two tertiary care centers to determine outcomes of AUS placement in patients who had undergone previous urethroplasty. METHODS A retrospective analysis of patients treated with AUS placement from November 2008 to December 2013 was performed at two tertiary care centers. All patients receiving AUS placement were included regardless of urinary incontinence etiology. Patients were divided into “average risk” (AR) and previous urethroplasty (PU) cohorts. Patients with a history of radiation therapy, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS and were excluded from the AR cohort. Charts were analyzed for pre-operative risk factors as well as post-operative complications, revisions, and pad usage. RESULTS 141 patients underwent AUS placement during the study period. 13 patients undergoing AUS placement had a history of previous urethroplasty (PU). Patients were included regardless of indication for urethroplasty. Indications for urethroplasty included urethral stricture, AUS erosion, and bladder neck contracture in 9, 3, and 1 patient respectively. 63 patients were considered average risk (AR). Post-operative complication rate was 15.4% (n=2, RR 1.38, p=0.66) in the PU group and 11.1% (n=7) in the AR group. Complications in the PU group included persistent bothersome incontinence and erosion each in a single patient. Mean postoperative pad use was 0.96 (n=53) in AR group vs 2.1 in PU group (n=8). Mean follow-up time was 10.9 months (range 1-35) for AR group and 4 months (range 1-9) for PU group. CONCLUSIONS Patients who had previously undergone a urethroplasty for any indication were not statistically more likely to develop a postoperative complication than “average risk” patients. Post-operative pad usage was twice that of the AR group. While longer follow-up is necessary, these data suggest that patients undergoing AUS placement following urethroplasty may have a similar complication rate to that of the general population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Powell More articles by this author Travis Dum More articles by this author William Brant More articles by this author Joshua Broghammer More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Risk Factors for Erosion of Artificial Urinary Sphincters: A Multicenter Prospective Study

To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection. A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation. Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs. This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up.

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

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. As a first step, multiple incisions were made around stricture site with cold-utting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a MemokathTM 044TW stent (40 - 60mm) on a pre-mounted sheath using 0° cystoscopy. Stents were removed within12 months after initial placement. 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 Qmax (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. 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.