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Published online before print December 11, 2002, 10.1148/radiol.2262012160
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(Radiology 2003;226:433-440.)
© RSNA, 2003

Vascular and Interventional Radiology

Recurrent Traumatic Urethral Strictures near the External Sphincter: Treatment with a Covered, Retrievable, Expandable Nitinol Stent—Initial Results1

Ho-Young Song, MD, Hyungkeun Park, MD, Tae-Suk Suh, MD, Gi-Young Ko, MD, Tae-Hyung Kim, BS, Eun-Sang Kim, BS and Taehan Park, MD

1 From the Departments of Diagnostic Radiology (H.Y.S., T.S.S., G.Y.K.), Urology (H.P., T.P.), and Biomedical Engineering (T.H.K., E.S.K.), Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea. From the 2000 RSNA scientific assembly. Received January 14, 2002; revision requested March 5; revision received May 3; accepted June 3. Supported by grant HMP-98-G-2-043 from the HAN (Highly Advanced National) Project, Ministry of Health and Welfare, Republic of Korea. Address correspondence to H.Y.S. (e-mail: hysong@www.amc.seoul.kr).

PURPOSE: To investigate the clinical effectiveness of a covered, retrievable, expandable nitinol stent in treating traumatic urethral strictures near the external sphincter.

MATERIALS AND METHODS: The stent was 10 mm in diameter when fully expanded and 40–50 mm long. To make it removable, two nylon drawstrings were attached to its lower inner margin. Twelve consecutive men (19–67 years; mean age, 47 years) with traumatic urethral strictures near the external sphincter that were refractory to endoscopic urethrotomy were treated. With fluoroscopic guidance, a stent was placed to completely bridge the external sphincter. The stent was electively removed with a retrieval hook wire 2 months after placement. Stent placement and removal were successful in all patients, with no procedural complications.

RESULTS: Mean maximum urine flow rate was 5 mL/sec (range, 3–7 mL/sec) before stent placement and 27 mL/sec (range, 16–40 mL/sec) at 1 week after placement. During the mean follow-up of 20 months (range, 2–37 months) after the first stent removal, strictures recurred in eight of 12 patients. For the eight patients with recurrence, a second stent was placed and 4 months later was removed from seven of the eight patients. During the mean follow-up of 18 months (range, 4–32 months) after the second stent removal, strictures recurred in two patients, in whom a third stent was placed and then removed 4 months later, with good results. Four (33%) of 12 patients, five (62%) of eight patients, and two (100%) of two patients were successfully treated with placement of the first stent, the second stent, and the third stent, respectively. In the remaining patient, the second stent remains in place.

CONCLUSION: Placement of a covered, retrievable, expandable nitinol stent seems to be effective in treating urethral strictures near the external sphincter and warrants further investigation.

© RSNA, 2003

Index terms: Genitourinary system, injuries, 84.43 • Urethra, interventional procedures, 84.1269 • Urethra, stenosis or obstruction, 84.847




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