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Vol. 43. Issue 1.
Pages 26-31 (January - February 2019)
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Vol. 43. Issue 1.
Pages 26-31 (January - February 2019)
Casuistry
Urethral reconstruction in patients previously treated with Memokath™ urethral endoprosthesis
Reconstrucción uretral en pacientes previamente tratados con endoprótesis uretral Memokath™
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J.C. Anguloa,
Corresponding author
javier.angulo@salud.madrid.org

Corresponding author.
, J. Pankajb, I. Arancea, S. Kulkarnib
a Departamento Clínico, Hospital Universitario de Getafe, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Getafe, Madrid, Spain
b Kulkarni Center for Reconstructive Urology, Pune, India
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Table 1. Series description.
Table 2. Surgical results of stent removal followed by urethroplasty.
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Abstract
Purpose

To evaluate the role and success rate of urethral reconstruction in patients with urethral stricture previously treated with thermos-expandable Memokath™ urethral endoprosthesis.

Materials and method

A case series of patients with urethral stricture and Memokath™ endoprosthesis treated with urethroplasty is presented. Reconstruction was decided due to stricture progression or complications derived from primary stent treatment. Age, stricture and stent length, time between stent placement and urethroplasty, mode of stent retrieval, type of urethroplasty, complications and voiding parameters before and after urethroplasty were evaluated. Successful outcome was defined as standard voiding, without need of any postoperative procedure.

Results

Eight cases with bulbar urethra stricture were included. Memokath™ was endoscopically retrieved before urethroplasty in 6 (75%) and by open urethrotomy at the time of urethroplasty in 2 (25%). Technique of urethroplasty was dorso-lateral onlay buccal mucosa graft in 5 (62.5%) cases and excision and primary anastomosis, anastomotic urethroplasty, and dorsal onlay buccal mucosa graft in one (12.5%) case each. There was no failure at 26±21.5 months median follow-up. Total IPSS, QoL, Qmax and postvoid residual significantly improved (p<.05). The only complication presented was epididymitis and penile shortening in one patient (12.5%).

Conclusions

Urethroplasty after re-stricture or other complications in patients with temporary Memokath™ urethral stent is a viable and definite option of reconstruction with excellent results in the short term and few complications. One-side dorsolateral onlay buccal mucosa graft augmentation is the optimal technique for this indication.

Keywords:
Urethra
Memokath™
Urethral stricture
Urethroplasty
Resumen
Objetivo

Evaluar el papel y la tasa de éxito de la reconstrucción ureteral en pacientes con estenosis de uretra tratada previamente con endoprótesis uretral termoexpandible Memokath™.

Material y método

Se presenta una serie de pacientes con estenosis de uretra y endoprótesis Memokath™ tratados con uretroplastia. La reconstrucción se decidió, bien debido a progresión de la estenosis, bien a complicaciones derivadas del tratamiento primario con el stent. Se evaluó la edad, la longitud de la estenosis y del stent, el tiempo entre la colocación del stent y la uretroplastia, el modo de retirada del stent, el tipo de uretroplastia, las complicaciones y los parámetros miccionales antes y después de la uretroplastia. Se considera resultado exitoso conseguir la micción espontánea sin necesidad de procedimiento postoperatorio.

Resultados

Se incluyeron 8 casos con estenosis de uretra bulbar. Memokath™ se retiró endoscópicamente antes de la uretroplastia en 6 casos (75%) y mediante uretrotomía abierta en el momento de la uretroplastia en 2 (25%). La técnica de uretroplastia fue: injerto de mucosa bucal onlay dorsolateral en 5 casos (62,5%) y escisión con anastomosis primaria, uretroplastia anastomótica e injerto de mucosa bucal onlay dorsal en un caso (12,5%) cada uno. No hubo ningún fracaso con una mediana de seguimiento de 26±21,5 meses. El IPSS total, la CdV, el Qmáx y el residuo postmiccional mejoraron significativamente (p<0,05). Como complicación, un paciente (12,5%) presentó epididimitis y acortamiento peneano.

Conclusiones

La uretroplastia tras reestenosis u otras complicaciones en pacientes con stent uretral temporal Memokath™ es una opción de reconstrucción viable y definitiva con excelentes resultados a corto plazo y pocas complicaciones. El injerto de mucosa bucal onlay dorsolateral de un solo lado es la técnica óptima para esta indicación.

Palabras clave:
Uretra
Memokath™
Estenosis uretral
Uretroplastia

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