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Management of Recurrent Urethral Strictures with Covered Retrievable Expandable Nitinol Stents: Long-Term Results

¹ Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2 Dong, Songpa-Gu, 138-736 Seoul, Korea.
² Weill Medical College of Cornell University, New York, NY.
³ Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

OBJECTIVE. The purpose of this study was to evaluate the long-term clinical efficacy of temporary placement of covered retrievable stents in the management of recurrent urethral strictures.

MATERIALS AND METHODS. During the period December 1998–December 2005, 32 men and one adolescent boy (mean age, 48.6 years; range, 16–73 years) with recurrent urethral strictures underwent fluoroscopically guided insertion of a total of 68 stents. Patients without complications underwent elective stent removal 2 or 4 months after stent insertion. Rates of clinical success (long-term clinical and radiographic resolution of urethral strictures) were assessed. The Mann-Whitney U test was used to compare the duration of stent placement in patients with long-term clinical resolution with that in patients with stricture relapse.

RESULTS. Clinical success was achieved in 18 (55%) of the 33 patients. The mean duration of stent placement in patients with clinical success was significantly different from that in patients who had recurrences (p < 0.0001). Stricture relapse did not occur in only four (20%) of 20 cases of stent placement for 2 months. All 14 stent placements lasting at least 4 months resulted in long-term resolution after a mean follow-up period of 3.6 years. The most common complications necessitating early stent removal were stent migration (33.8% of stents) and tissue hyperplasia (20.6% of stents).

CONCLUSION. Placement of a covered retrievable stent for a minimum of 4 months is effective in inducing long-term resolution of refractory urethral strictures. Stent migration remains the largest obstacle in achieving adequate duration of stent placement.

Keywords: fluoroscopy • interventional radiology • stent • urethral stricture

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