Stents and urethral strictures: a lesson learned?

Originally developed for vascular use, the concept of maintaining the patency of a lumen with a self-retaining endoprosthesis dates back to 1969. In 1980, Fabian was the first to describe the use of a stent in the lower urinary tract to maintain patency of the prostatic urethra in patients with benign prostatic hyperplasia [1]. Subsequently, the indications expanded to include treatment of detrusor sphincter dyssynergia due to spinal cord injury and, in 1988, treatment of urethral strictures [2]. Initially, a temporary Urocoil stent was tested, but since 1990 the permanent Urolume has been advocated as the endoprosthesis of choice for urethral stricture disease; it is a biocompatible stent made from a super-alloy and woven into a tubular mesh [1]. After initial enthusiasm and expanding indications for various stenoses, the stents have been shown to fail in posterior strictures resulting from pelvic trauma or from prostatic surgery [1,3]. To date they have not been promoted for use in penile strictures. The advocated use in the bulbar urethra has still to be fully evaluated. Numerous reports have been published regarding the efficacy, safety, and reversibility of this device in bulbar strictures. The Urolume has been reported to have an 86–100% success rate for treating stenoses in the short term (<18 mo) and a 42–90% success rate in the medium term (24–36 mo) [4–7]. Long-term results (>10 yr) show further deterioration with only a 13–45% success rate reported [4,8]. Shah et al report a 67% success rate, but only 24 of 179 patients who had stents implanted were available for follow-up, and