Long-term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis

UROLOGICAL SURVEY

RECONSTRUCTIVE UROLOGY

Long-term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis

Sertcelik MN; Bozkurt IH; Yalcinkaya F; Zengin K

Ankara Diskapi Yildirim Beyazit Training and Research Hospital 1. Urology Clinic, Ankara, and Department of Urology, Karaman State Hospital, Karaman, Turkey

BJU Int. 2011 Jul; 14. doi: 10.1111/j.1464-410X.2011.10230.x. [Epub ahead of print]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Milroy reported 84% success at a mean of 4.5 years follow-up by usage of a permanently implantable "urolume" spent in 1993. Memotherm was developed later, especially for urologic use. Our study is one of the largest in this urea, with a high number of patients and a long follow-up period.

OBJECTIVE: To evaluate the effectiveness and long-term results of permanent urethral stent (Memotherm) implantation in the treatment of recurrent bulbar urethral stricture.

PATIENTS AND METHODS: In all, 47 patients with a history of previous unsuccessful treatment for bulbar urethral stricture were treated using Memotherm bulbar urethral stents between 1998 and 2002. Long-term follow-up data was analysed and discussed.

RESULTS: At the end of the 7-year period 37 of 47 patients (78.7%) had been treated successfully. Post-micturition dribbling incontinence lasting up to 3 months after stent placement occurred in 32 (68.1%) patients, but this was reduced to only seven patients (14.9%) by the 7-year follow-up. There was stress incontinence of various severities in nine (19.2%) patients at the 1-year follow-up. These patients were those who had stenosed urethral segments adjacent to the external sphincter. At the long-term follow-up < 10% of the patients had stress incontinence complaints.

CONCLUSION: Memotherm is a good treatment option in patients with recurrent bulbar urethral stricture of any cause.

doi: 10.1590/S1677-55382011000000000

Editorial Comment

Currently, the management of bulbar urethral strictures is limited to dilation, urethrotomy and urethroplasty. An attractive compromise between the invasiveness of these options would be a permanently implanted urethral stent. Stents also promise the hope of drug-eluting versions which might help prevent stricture recurrence. Indeed, the Memotherm urethral stent is an attractive candidate for this role and has two distinct theoretical advantages over the older Urolume stent. First, the Memotherm expands at body temperature and contracts at colder temperatures, making it easier to remove. Second, it is a wall stent rather than a mesh stent like the Urolume which might limit the hyperplastic reaction. The current investigation is a retrospective study which reports outcomes at 7 years. However, nearly 50% needed a second procedure within that time frame and hyperplastic reaction was not uncommon. The authors posit that urethral stent placement should be the treatment of choice for urethrotomy failure as urethroplasty can always be performed later with good results. However, urethroplasty after Urolume stent removal frequently requires a 2-stage procedure (1). We look forward to prospective randomized trials of urethral stents.

Dr. Sean P. Elliott

Department of Urology Surgery

University of Minnesota

Minneapolis, Minnesota, USA

E-mail: [e-mail]

• 1.   Eisenberg ML, Elliott SP, McAninch JW: Management of restenosis after urethral stent placement. J Urol. 2008; 179: 991-5.

Publication Dates

• Publication in this collection
  19 Oct 2011
• Date of issue
  Aug 2011