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

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.

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.

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.

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.