The long-term results of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture disease

ABSTRACT Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed. Results: The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively. Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.

Role of sonourethrography in evaluation of anterior urethral stricture and its comparison with retrograde urethrography

The aim of this study was to compare retro grade urethrography [RUG] and sonourethrography [SUG] for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Quasiexperimental study. The study was performed in the department of Radiology PNS Shifa Karachi from January 2004 till December 2004. Forty male patients diagnosed with anterior urethral stricture were assessed for presence of strictures and their length by conventional contrast urethrography and sonourethrography. Contrast urethrography was carried out by retrograde injection of Urograffin 76% under fluoroscopic guidance. Sonourethrography was done with a 7.5 MHz small parts transducer. Stricture lengths were recorded and compared. Analysis of the results showed that the estimation of stricture length measured by contrast urethrography was under-estimated as compared to sonourethrography. The difference between the two tests was significant [P < 0.001] and the correlation coefficient was poor [r = 0.493]. When the strictures were grouped into penile and bulbar anatomical locations the results remained highly significant in the bulbar region [P = 0.0001] however no significant difference was found in the estimated length for penile strictures [P = 0.25]. Sonourethrography is a good adjunct investigation before definitive surgical therapy particularly in the bulbar region where conventional contrast urethrography was shown to underestimate stricture length significantly

Urethro-venous intravasation during retrograde urethrography (report of 5 cases).

Five instances of urethro-venous intravasation during retrograde urethrography are reported. Four cases were of urethral strictures and one case was of urethral hemangioma. All patients had post procedural bleeding while one patient got allergic reactions, another showed chills and rigors. Anatomy of the drainage veins is described. Factors responsible for this complication and its clinical implications are discussed. It is suggested that urethro-venous intravasation should be considered a diagnostic sign of urethral inflammation.

role of visual urethrotomy in the primary treatment of obliterated posterior urethral structures

Ten cases of obliterated posterior urethral stricture were managed with visual urethrotomy. A half circle C shaped sound was introduced through the supra public cystostomy into the posterior urethra and was used as a guide for urethrotomy. When the sound was impossible to pass into the posterior urethra, methylene blue dye was installed in the bladder and used instead of the sound. Nine patients out of 10 had acceptable urine flow rate after visual urethrotomy. Visual urethrotomy is a simple, repeatable, safe and useful procedure for the management of stricture urethra. The long-term results were not guaranteed and the follow up for long periods was recommended