Wednesday, March 24, 2010

Memocath stent insertion for a case of long segment urethral stricture disease

We had a 24-year-old gentleman - a case of recurrent stricture urethra.He had undergone multiple endoscopic interventions and was on regular dilatations.The ascending urethrogram has revealed long segment bulbar urethral stricture disease.The etiology of the stricture was most probably infective one with no history of prior instrumentation of surgery related to urinary tract.

He was given options of urethroplasty -substitution with the buccal mucosal graft and the Memocath- stent insertion.
The patient underwent stent insertion.The procedure took 45 minutes; it was done under spinal anaesthesia.The patient immediately resumed normal activities the very next day.
He started voiding immediately as no catheter kept after the procedure.

The insertion of the stent has a very few and only minor side effects.It has immediate effect on voiding.The stent does not interfere with normal bladder control.
As such there no contra-indications for the stent insertion but stone disease,need for urological intervention in future for some other problem like prostatomegaly or recurrent Urinary Tract Infections can be a relative contra-indication for the procedure.
We inserted The Memocath 044 stent which expands from CH 24 TO CH 44 after warm saline irrigation.The stent comes under various sizes 3 cm,4 cm, 5cm, 6 cm amd 7 cm .We used 7 cm stent for this patient.

The patient voided with superflow 60 ml/sec and continues to void with the good stream 4 days pos-operatively.
He is planned for Retrograde Urethrogram after a period of 1 month along with uroflowmetry.

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