Management of the failure of a permanently implanted urethral stent - A therapeutic challenge

Objectives: To demonstrate the surgical challenges posed and strategies that can be adopted to deal with failed stent insertion after prior urethroplasty or traumatic injury to the urethra. Methods: A case series of 14 patients (mean age, 48 yr; range, 32-61) who developed a urethral restenosis after urethral stent insertion into a stricture that either occurred after blunt trauma or recurred after a failed urethroplasty. Results. In 9 of 14 patients, stricture formation was attributed to blunt trauma, and in the remaining 5 patients, the stricture in 3 was secondary to a failed previous urethroplasty for a hypospadiac deformity and, in 2, occurred after a failed urethroplasty performed for other indications. The mean duration for a stent to remain in situ prior to its removal due to failure was 26 mo (range, 3-85). The mean follow-up period for this group of patients was 37 mo (range, 14-72). Four patients who had undergone urethroplasty prior to stent insertion required more than two interventional procedures to make them stricture free. Conclusions: Our findings indicate that failure of a permanently implanted stent represents a major surgical challenge. Implantation of these stents should be avoided for strictures that recur after either blunt trauma or surgical trauma to the urethra associated with a prior urethroplasty. In this series buccal mucosa was used as a graft for substitution in four patients, and all patients in this group were rendered stricture free without the need for any additional procedures. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.