Preservation of lower urinary tract function in posterior urethral stenosis: selection of appropriate patients for urethral stents.
OBJECTIVE
We describe our experience with urethral stents to manage iatrogenic posterior urethral stenosis.


METHODS
We surveyed our retrospective database for patients in whom we placed a urethral stent for posterior urethral stricture disease. We reviewed patient age, comorbidities, indications for stent placement, stricture length, postoperative complications and the repeat stenosis rate.


RESULTS
Overall we placed urethral stents in 13 patients, of whom 12 presented with posterior urethral stenosis and 1 presented with anterior and posterior stricture. The etiology of urethral stricture was prostate cancer therapy in 11 of 13 cases and simple prostatectomy in 2. Urethral stenting was chosen instead of urethral reconstruction largely due to prior radiation for prostate cancer and avoidance of the morbidity of surgery. Overall 6 of 13 patients required additional procedures for stricture recurrence, including 5 in previously irradiated patients. Two patients had stents removed due to migration or pain. Genitourinary infections developed in 5 of 13 patients. Eight of 13 patients with a posterior urethral stricture were incontinent, as expected after stent placement. Incontinence was managed by an artificial urinary sphincter in willing patients with 9 of 13 continent.


CONCLUSIONS
Urethral stents provide reasonable treatment for patients with posterior urethral stenosis when attempting to preserve lower urinary tract function caused by stricture disease after prostate cancer therapy. Prior radiation seems to increase the failure rate. Continence can be maintained after posterior urethral stenting in select patients.
Eisenberg
Michael L
ML
University of California-San Francisco and San Francisco General Hospital, San Francisco, California 94110, USA.
Elliott
Sean P
SP
McAninch
Jack W
JW
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology* / Q000628:therapy*; D014549:Urinary Incontinence / Q000517:prevention & control*; D014554:Urination / Q000502:physiology