Endoscopic urethroplasty with a free graft on a biodegradable polyglycolic acid spiral stent. A new technique.

Abstract

Explore the possibility of an endoscopic urethroplasty with a free graft on a biodegradable, self-reinforced polyglycolic acid spiral stent. Urethral strictures, failures of previous urethrotomies, which still can be incised endoscopically are selected. Strong fibrotic strictures which are bad indications for the use of a free graft are excluded. A free graft (skin on mucosa) is sutured around the stent and brought at the place of the endoscopically opened stricture where the graft is fixed with a suture through skin, bulbar muscles and spongiosum. A suprapubic diversion is left for 10 days. The stent keeps the graft in contact with surrounding well vascularized tissue where it can take. Other parts of the graft become necrotic. The stent hydrolyses in about 3 weeks. 10 patients with bulbar strictures from 2 to 4 cm in length and failed previous urethrotomies were treated successfully with this technique. The follow-up varies from 39 to 3 months (mean: 21 months). After 2 years 1 stricture recurred in a man who underwent regular endoscopies for recurrent bladder tumors. All other patients were successful until now. One stent got lost in the bladder during the procedure but could be brought at the right place. Other complications were 1 hematuria, 1 urosepsis, 1 perineal pain, 1 painful evacuation of a part of the stent 16 days after operation, and 1 difficult micturition. The preliminary experiences indicate that this technique is a possible treatment of short bulbar strictures after failure of endoscopic treatment.