A thermo-expandable stent (MemokathTM, Pnn Medical, Denmark) have currently used for recurrent bulbar urethral stricture. However, many complications which needed removal of stent, such as recurrent stricture, migration of stent, encrustation, and infection, have been reported in some studies and re-surgical treatment as urethroplasty or visual internal urethrotomy have been needed in many cases. Thus, we investigated the outcomes of voiding parameters and sexual function of visual internal urethrotomy after removal of urethral stent (MemokathTM).

From January 2011 and December 2015, thirty-five patients who underwent visual internal urethrotomy immediately after removal of urethral stent (MemokathTM) because of re-stricture within 1 year were included in this study. Successful outcome was defined as normal voiding pattern, without need of any postoperative procedure until 3 years after surgery. We analyzed voiding parameters, including International Prostate Symptom Score (IPSS), Qmax, and residual urine, and sexual function parameter, using Male Sexual Health Questionnaire (MSHQ) at preoperative, postoperative 1 year, 2 years, and 3 years.

The mean age was 47.5±11.6 years and the mean interval between implantation and removal of urethral stent (MemokathTM) was 7.4±2.6 months. After removal of stent, all of patients newly had urethral stricture and stricture portions were reported in follows: 14 anterior stricture; 21 bulbo-membranous stricture and the mean stricture lengths were 8.4±6.5 mm. The recurrence free survival (RFS) rate was 98.71%, 94.48%, and 87.19% at 1, 2, and 3 years, respectively. No difference in RFS was observed regarding the site of stricture (log-rank, p=0.497). With voiding parameters, total IPSS, QoL, Qmax, and PVR significantly improved after postoperative 1 year (p=0.009, <0.001, <0.001, and 0.01, respectively). In terms of sexual function, erection and satisfaction domain score were significantly improved after postoperative 1 year, compared with urethral stent (p<0.001 and p=0.032, respectively).

All patients who underwent removal of the thermo-expandable urethral stent had newly urethral stricture, with not previous urethral stricture. Location of stricture was proximal and distal end part of urethral stent and we hypothesized that it is because each end part of urethral stent were wider than the body of urethral stent. After VIU, the recurrence free survival (RFS) rate of urethral stricture was 98.71%, 94.48%, and 87.19% at 1, 2, and 3 years, respectively.

Although there are many cases that thermo-expandable urethral stent (MemokathTM) is removed by re-stricture, visual internal urethrotomy immediately after removal of urethral stent is an effective surgical treatment of reconstruction with a high recovery rate of sexual function as well as high success rate and few complications.