Endoscopic Surveillance of Self-Expandable Metal Prostheses in Recurrent Urethral Strictures

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Abstract
Eighteen self-expandable metal prostheses inserted for the treatment of recurrent urethral strictures produced excellent clinical results in 13 of 17 patients after a mean follow-up of 9 months. Two patients developed a new stricture, and two patients suffered from persistent urinary stress incontinence at 6 and 12 months that was unrelated to the position of the prosthesis. None of the prostheses were removed. Regular endoscopic surveillance revealed three types of clinical course: favorable, resulting in complete epithelialization, which was the most common situation, being observed in six of the seven patients followed for more than 12 months; intermediate, defined as persistence of granulation tissue after the ninth month or predominant fibrosis without stricture, with an uncertain long-term prognosis; and unfavorable, with partial recurrence of the stricture, seen in two patients with a history of five urethrotomies. No stent migration or incrustation was observed. No contraindications can be defined on the basis of this limited follow-up and the small number of patients treated, but the quality of the results encourages the authors to pursue this treatment modality for recurrent urethral strictures and suggests the possibility of using this prosthesis for the treatment of other strictures or obstructions of the urinary tract.