Friday, April 23, 2010

Easy solution for the urethral stricture: Urethral stent insertion

A 48 year old gentleman came with recurrent stricture urethra-proximal bulbar region.He had undergone multiple endoscopic interventions-Optical Internal Urethrotomies and repeated dilatations. Patients flow before the surgery He was also a case of diabetes on oral hypoglycemic agents and thus prone for recurrent Urinary Tract Infections also. His investigations were within the normal limits.His Blood Sugar levels were fairly well controlled. Clinical examination revealed Balanitis Xerotica Obliterans as the cause of the urethral stricture. Retrograde urethrogram showed proximal bulbar stricture. He was given the options of Buccal Mucosal Graft Urethroplasty and urethral stents.The patient was wary of any surgery and opted for day care stent surgery. Memocath stent insertion was done for the patient.Intra-operative assessment of the stricture length was 5.5 cm reaching just near the External Urethral Sphicter.So a 7 cm Urethral stent was inserted just touching the sphincter proximally and covering extra 0/5 cm beyond the stricture distally.This was done keeping in mind the stricture length always extends 5-10 mm beyond the visible stricture(microscopic extension of the disease). After the surgery the patient went into post-obstructive diuresis( a phenomenon noted after relief of long standing obstruction) and so his stay was extended by 2 days and then he was discharged. His urinary stream was good and he was voding with Maximum Flow rate of 49 ml/sec.

1 comment: