Elimination of recurrent bulbar urethral stricture with urethroplasty after inserting wallstent
DOI: 10.22591/magyurol.2017.1.széllt.5
Authors:
Széll Tamás dr., Kelemen Zsolt dr., Nyirády Péter dr. Semmelweis Egyetem ÁOK, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.)
Summary
Objective: In the cases of elimination of urethral strictures the indication of wallstents are doubtful, they usually have only a very small indication range. Spongiofibrosis, which is caused by external or iatrogenic harm, impairs the blood supply of corpus spongiosum, reduces the success rate of wallstents. Initially the wallstents raised hope, because publications supported short term efficiency, but the medium and long term efficiency was not confirmed.
Case report: In our case multiple urethrotomia interna was performed because of recurrent bulbar urethral stricture. Within a short time urethral stricture developed again and – in another institution – metal wallstent was inserted. After 11 years scar tissue caused partial obstruction in the hole of wallstent, which was treated by laser vaporisation. Opioid analgesic claiming perineal pain and total urinary retention evolved after temporary achievement, because of urethroplasty was performed in our institution. The severe scar and hyperplastic tissue growth and the entirely obstructed urethra with the wallstent together were resected until the membranous urethra. After 8 months of undisturbed postoperative period the patient does not have complaint, he has outstanding average and maximum urinary stream and he is continent.
Conclusion: At first sight the wallstent offers an obvious solution of elimination of urethral strictures, but it gets the worst of the long term efficiency over against the success rate of urethroplasty. As a foreign body increases the spongiofibrosis, which aggravates the extant urethral stricture and further on it throws difficulties in the way of the necessary urethroplasty, just like two steps/substitution urethroplasty is required.
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