Transurethral
placement of the UroLume® Urethral Stent is a minimally invasive
procedure that can typically be performed within 10-30 minutes.¹
Caution:
This information is for educational purposes only. See the Operating
Room manuals, Instructions for Use and videos for more detailed
instructions about this procedure.
1.
Rivas DA, Chancellor MB, Bagley D. Prospective comparison of external
sphincter prosthesis placement and external sphincterotomy in men with
spinal cord injury. J Endourol Apr 1994 v. 8(2) p.89-93.
Instrumentation
The
UroLume stent is delivered sterile and preloaded in a disposable
delivery tool. The delivery instrument has an inner lumen to receive a
standard, 12Fr optical telescope (cystoscope) for direct visualization
of the stent and the urethra throughout the procedure. The irrigation
port permits a constant washing of the urethra and telescope to allow
for better visualization.
The delivery instrument features a
retractable sheath. By manipulating the finger grips, you are able to
draw back and advance the sheath until you find the optimum position for
deployment.
To prevent inadvertent release of the stent during
the procedure, the delivery instrument is equipped with two security
buttons. The rounded, 24Fr collar at the tip of the delivery tool eases
insertion into the urethra.
Instrumentation for the procedure includes:
- Urethral sounds
- A 12Fr optic telescope (0-30 degrees for DESD)
- An irrigation setup
- Cystoscope
- AMS Urethral Measuring Catheter or a graduated ureteric catheter
- UroLume stent kits (at least two of each size)
Procedure Overview
Typical
patient preparation includes preoperative antibiotics, placing the
patient in the lithotomy position, skin prep and drape and anesthesia.
Anesthesia varies according to the disease being treated. For DESD,
spinal or general anesthesia is used to prevent erections or autonomic
dysreflexia in patients with high level spinal cord injury. Lidocaine
jelly may be used for patients who are not susceptible to autonomic
dysreflexia or who do not desire to use anesthesia.
The placement
procedure consists of the following steps. Caution: This information is
for educational purposes only. Refer to Operating Room manuals and
procedure videos for more detailed instructions on this surgical
procedure.
Step 1: Cystourethroscopy
To
prepare for placement of the UroLume stent, perform a diagnostic
cystourethroscopy. If it is not possible to pass a cystoscope through
the strictured portion of the urethra, dilate the stricture or perform
urethrotomy to allow the instrument to pass.
Step 2: Measurement
Use
an AMS Urethral Measuring Catheter or a graduated ureteric catheter to
take the appropriate measurements. In a patient with DESD, measure the
length of the external sphincter.
Step 3: Stent Selection
The
method for selecting the correct size varies according to the disease.
For DESD, select a stent that is 0.5 cm longer than the measured length
of the external sphincter. Physicians generally use a 3.0 cm stent for
the initial insertion. To ensure that the entire external sphincter is
covered, an additional stent or stents may be used in combination.
Step 4: Delivery Tool Preparation
Open the selected UroLume package and prepare the deployment system for the procedure:
- Attach the light source to the telescope.
- Attach the water source to the irrigation port on the delivery instrument.
- Insert the telescope into the telescope stabilizer and then place the stabilizer into the delivery instrument.
- Apply a small amount of sterile lubricant over the outer shaft to facilitate passage into the urethra.
Step 5: Stent Placement
- Dilate the meatus to at least 24Fr and insert the delivery instrument into the urethra.
- Position the delivery instrument so that its rounded collar is
in the correct location. For DESD patients, this at the apex of the
prostate.
- Partially deploy the stent and reposition it if necessary.
- Release the stent.
- Withdraw the delivery tool.
Some important points about stent placement for DESD patients:
- During placement, the distal edge should extend at least 5 mm into the bulbar urethra.
- The proximal edge should cover the caudal half of the verumontanum.
- The stent(s) must cover the length of the external sphincter.
- If more than one stent is required to adequately cover the
external sphincter, the first stent placed should cover the most
proximal (nearest the verumontanum) end of the external sphincter. The
stents should overlap by at least 5 mm.
Step 6: Endoscopy
Proceeding with care, perform normal endoscopy.
Post-Operative Care
Routine
post-procedural care should include prophylactic antibiotics. Do not
use a urethral catheter and do not perform a cystoscope for eight weeks
until the stent is stabilized by urothelial ingrowth. Additionally,
patients should be counseled to avoid activities that place abnormal
forces upon the urethra, such as frequent cycling or horseback riding. |
