Urethral Stents. Indications, Complications and Adverse Effects (original) (raw)
Related papers
Prostatic stents for the treatment of benign prostatic hyperplasia
Current Opinion in Urology, 2007
The insertion of prostatic stents in the treatment of lower urinary tract symptoms in men secondary to benign prostatic obstruction from benign prostatic hyperplasia has proven to be an effective modality in properly selected patients. We review the current literature on the role of prostatic stents in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. Permanent stents such as the Urolume and the Memokath offer efficacious and safe treatment alternatives for men with bladder outlet obstruction from benign prostatic hyperplasia who are deemed high surgical risks for traditional transurethral resection of the prostate. When removal of permanent prostatic stent is necessary, the design of the Memokath allows for an easier removal than that of the Urolume. Temporary stents are being investigated as a means to treat the transient bladder outlet obstruction frequently observed after minimally invasive thermotherapy procedures aimed at treating benign prostatic obstruction, with both biodegradable and retrievable stents shown as successful modalities for this indication. Prostatic stents remain an option to treat men with benign prostatic obstruction/bladder outlet obstruction; however, stent migration remains an obstacle to their widespread use. The key to obtaining optimal outcomes in men with benign prostatic hyperplasia is careful patient selection and experience with proper stent deployment.
A novel temporary prostatic stent for the relief of prostatic urethral obstruction
BJU International, 2004
and deflates the proximal balloon when pulled. The stent was inserted under topical anaesthesia in 30 patients. The maximum flow rate (Q max), voided volume (VV), postvoid residual (PVR), the International Prostate Symptom Score (IPSS) and stent position were assessed. RESULTS Stents remained in situ for a mean (range) of 57 (1-98) days. The mean overall Q max at baseline and after insertion were 8.2 and 11.6 mL/s, representing a 42% improvement (P < 0.001); the respective mean overall VVs were similar, at 219.7 and 221.6 mL (0.9% increase, not significant) and the PVRs were 312.1 and 112.3 mL, representing a 64% decrease (P = 0.004). The overall mean IPSS declined from 22.3 before to 7.1 after insertion, representing a 68% decrease (P < 0.001). There were only minor adverse events. The stability, patency and lack of migration of the device were confirmed radiographically up to 12 weeks of use. CONCLUSIONS This early study shows that this temporary prostatic stent is easily inserted and removed, remains anchored in position, and significantly improves the Q max , PVR and IPSS while preserving volitional voiding and continence.
New developments in the use of prostatic stents
Open Access Journal of Urology, 2011
Bladder outflow obstruction is a very common age-related clinical entity due to a variety of benign and malignant diseases of the prostate. Surgical treatment under general or regional anesthesia is not suitable for high-risk elderly patients who seek minimally i nvasive management. Unfortunately, for patients who are not fit for transurethral and/or laser p rostatectomy, few treatment options remain, other than long-term catheterization and i nsertion (under local anesthesia) of a prostatic stent. In this review, we present developments in the use of prostatic stents.
Histological Changes Associated With Long-Term Urethral Stents
J Urol, 1999
Objective To assess the histological changes found in (seven), chronic inflammation (15) with prominent plasma cell infiltrates (11), variable foreign-body patients with long-term external sphincter, prostatic and urethral stents. granuloma (two) and microabscess formation (five), usually associated with clefts formed around the stent Patients and methods Eighteen patients with long-term stents (mean time since insertion 3.5 years) were wires (three of five). Conclusion Stents become incorporated into the urethral investigated. Three had external sphincter stents for detrusor-sphincter dyssynergia secondary to spinal wall by a process of polypoid hyperplasia through the stent mesh, with at least focal covering of the stent in injury, eight had prostatic stents for obstruction secondary to benign prostatic hyperplasia and seven had most cases, and with variable inflammatory infiltrates, most of which are rich in plasma cells. The urothelial urethral stents for recurrent strictures. Nine stents were occluded at investigation, of which seven were and connective tissue proliferation resulted in obstruction of the stent lumen in nine of the patients studied. entirely removed. The mucosae overlying the remaining two were biopsied, as were mucosae over the nine Further long-term study is necessary to exclude the development of carcinoma in patients with keratiniz-patent stents, at urethroscopy. Results The changes observed included polypoid ing squamous metaplasia, although no malignancy was seen in this study. hyperplasia (11 of 18 patients) between and around the stent mesh wires, nonkeratinizing squamous meta-Keywords Urethral stent, hyperplasia, squamous metaplasia plasia (two) or hyperkeratotic squamous metaplasia age and time in situ of the stents for all patients and the
Urethral Strictures and Stenoses Caused by Prostate Therapy
Reviews in urology, 2016
The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient's overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty.
Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction
Medical Devices: Evidence and Research, 2011
The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following highenergy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes.
Journal of endourology / Endourological Society
Introduction: Several prostatic stents were developed in the last three decades, none of which were able to provide a real alternative in patients unfit or unwilling to undergo classical prostatic surgeries. In this study, we report the results of the use of a newly developed prostatic stent-the AlliumÔ Triangular Prostatic Stent (TPS). Patients and Methods: The Allium TPS is a highly flexible, nitinol-built polymer-covered stent, which prevents tissue ingrowth and reduces encrustations. Between 2008 and 2014, at two centers (Israel and Turkey), the stent was inserted under local or regional anesthesia in 51 patients with benign prostatic obstruction (BPO) who are unwilling or unfit for surgery. Patients were followed for 12 months from surgery. The primary outcome was symptom improvement as measured by the international prostate symptom score (IPSS) and improvement in peak urinary flow. Results: Stent insertion was successful in all patients. The mean IPSS decreased from 26.4 to 7.7 on the last follow-up. The mean peak flow increased from 5.5 mL/second before stent insertion to 16.0 mL/second 1 year thereafter. The main adverse effect was transient pain in nine patients. No stent migration or obstruction was seen. Patients reported satisfaction and improvement in quality of life. Conclusion: Our short-term results show that Allium TPS is safe and effective for the treatment of patients with BPO.