Removal of Endoprosthesis with Urethral Preservation and Simultaneous Urethral Reconstruction

PurposeWe describe our experience with, and technique and outcomes of complex UroLume® stent extraction with simultaneous urethral preservation and reconstruction.Materials and MethodsA retrospective review of our institutional review board approved database identified 12 patients who underwent successful UroLume stent extraction with urethral preservation using a standard atraumatic approach between 2000 and 2011. Patient demographics, indication for stent removal, number of stents removed, and stricture length, location and etiology are described. Urethral reconstruction type and outcomes were analyzed.ResultsUrethral preservation was possible in all cases. No patient required en bloc urethral resection. A total of 16 stents (12 anterior and 4 posterior urethra) were successfully removed by standard vertical urethrotomy with wire extraction. Average patient age was 52.8 years and mean stricture length was 6.7 cm. Obstruction or recurrent stricture in 83% of cases, pain in 42% and urinary tract infection in 33% were the main indications for extraction. Eight patients underwent dorsal onlay urethroplasty, 3 ventral onlay urethroplasty (with a gracilis muscle flap in 2) and 1 perineal urethrostomy. Ten of the 12 patients (83%) were stricture-free at a median followup of 4 years. One patient treated with 12 cm ventral fasciocutaneous flap reconstruction required repeat urethroplasty. Treatment failed in a morbidly obese patient with a history of external beam and brachytherapy radiation for prostate cancer, requiring suprapubic tube diversion.ConclusionsRemoval of the dysfunctional UroLume stent using an atraumatic technique allows for urethral preservation and simultaneous urethral reconstruction. En bloc urethral resection and tissue loss are not necessary for stent extraction and successful urethral reconstruction.