使用Allium尿道支架處理新尿道狹窄: 台灣首例病例報告

莊德彥、王炯珵¹

恩主公醫院泌尿科；¹中原大學生物醫學工程系

Management of Neourethral Stricture Using Allium Urethral Stent: Taiwan First Case Report

Te-Yen Chuang, Chung-Cheng Wang¹

Department of Urology, En Chu Kong Hospital, New Taipei City.

¹Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li

     This 49 years old man has history of penile cancer s/p partial penectomy and neourethral reconstruction 6 years ago. He suffered from voiding difficulty and weak stream after operation. Several episodes of recurrent urethral stricture s/p optic urethrotomy and urethral sounding were noted. During recent 2 years, he suffered from voiding difficulty and urine leakage from middle penile shaft. Neourethral stricture and cutaneous urethral fistula were noted. Several times of urethral dilation and urethral repair were performed, but still in vain.

     The Allium Bulbar Urethral Stent (Allium, Allium LTD, Caesarea, Israel) is a fully covered, self expendable, large caliber metal stent specialy designed for the treatment of recurrent urethra strictures. The stent is comprised of a coiled super-elastic structure covered by a polymeric coating designed to prevent mucosal hyperplasia through the stent wires and into the lumen as well as reduce encrustation, stone formation and calcification. The stent is intended for a long term use for the purpose of opening the occluded urethral passage and to allow spontaneous urination.

Under general anesthesia, patient was placed as lithotomy position, Cystoscopy examination and a cystofix were performed first. Stent insertion was done using a gun-like delivery system on which the stent in mounted and is deployed gradually. After measuring the length of the stricture, the stent was placed endoscopically, under vision, just covering the stricture site. No intraoperative complication was noted.

We encouraged patient try to void 3-day after stent inserting. The peak uroflowrate increased from 1.2cm/sec to 8.4cm/sec. The voided volume increased from 92mL to 162mL. Post-voiding residual urine deceased from 105mL to 18mL. Patient was very satisfied with the procedure and the cystofix was removed. In conclusion, we reported the first case of refractory urethral stricture and successfully treated by Allium urethral stent in Taiwan.