Endoscopic urethroplasty with a free graft on a biodegradable polyglycolicacid spiral stent - A new technique

Objectives: Explore the possibility of an endoscopic urethroplasty with a f ree graft on a biodegradable, self-reinforced polyglycolic acid spiral sten t. Methods: Urethral strictures, failures of previous urethrotomies, which sti ll can be incised endoscopically are selected. Strong fibrotic strictures w hich are bad indications for the use of a free graft are excluded. A free g raft (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 sutu re through skin, bulbar muscles and spongiosum. A suprapubic diversion is l eft for 10 days. The stent keeps the graft in contact with surrounding weft vascularized tissue where it can take. Other parts of the graft become nec rotic, The stent hydrolyses in about 3 weeks. Material and Results: 10 patients with bulbar strictures from 2 to 4 cm in length and failed previous urethrotomies were treated successfully with thi s technique. The for low-up varies from 39 to 3 months (mean: 21 months). A fter 2 years 1 stricture recurred in a man who underwent regular endoscopie s for recurrent bladder tumors. All other patients were successful until no w. One stent got last in the bladder during the procedure but could be brou ght 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 o peration, and 1 difficult micturition. Conclusion: The preliminary experiences indicate that this technique is a p ossible treatment of short bulbar strictures after failure of endoscopic tr eatment. Copyright (C) 2000 S. Karger AG, Basel.