Biodegradable braided poly(lactic‐co‐glycolic acid) urethral stent combined with dutasteride in the treatment of acute urinary retention due to benign prostatic enlargement: a pilot study

Abstract

OBJECTIVE To evaluate, in a pilot study, the efficacy and safety of combining a braided poly(lactic‐co‐glycolic acid) (PLGA, a copolymer of l‐lactide and glycolide) urethral stent and dutasteride in the treatment of acute urinary retention (AUR) due to benign prostatic enlargement (BPE). PATIENTS AND METHODS Ten men with AUR due to BPE were treated as outpatients. A biodegradable braided PLGA urethral stent was inserted into the prostatic urethra, using a specially designed insertion device under visual control. Dutasteride treatment was started and the patients were followed up for 3 months after insertion of the stents. RESULTS In all patients the stents were placed successfully with the new insertion device. All men were able to void after inserting the stent. At 1 month five patients voided freely with a low residual urine volume (<150 mL), two voided but had a high residual urine volume and a suprapubic catheter was placed, and three needed a suprapubic or an indwelling catheter before 1 month, due to AUR or comorbidities. At 3 months five patients were voiding with no problems. CONCLUSIONS We have developed a new and effective insertion device for biodegradable braided prostatic stents. The new braided‐pattern stent overcomes the earlier problems of migration and sudden breakage into large particles associated with biodegradable spiral stents. However, the mechanical properties of the new stent need to be improved and tested in a longer follow‐up. We consider that this new biodegradable braided‐pattern urethral stent could provide a new option in the future treatment of AUR.

Systematic review and meta-analysis on management of acute urinary retention

“…55 Use of a bio-absorbable braided urethral stents is also being piloted in regard to its efficacy and safety and has yielded promising results when combined with dutasteride (LE: IV). 56 All subjects (n = 10) were able to void short term and 50% of subjects were still able to spontaneously void at 3 months. 56 …”

“…56 All subjects (n = 10) were able to void short term and 50% of subjects were still able to spontaneously void at 3 months. 56 …”

New developments in the use of prostatic stents

“…A biodegradable braided poly(lactic-co-glycolic acid) (PLGA) prostatic stent has been used in combination with dutasteride for the management of acute urinary retention. 24 Ten such patients were able to void after the stent insertion, and half of them continued to be able to do so after 3 months. None of the patients had any migration of the stent or incontinence due to the stent.…”

“…This novel braided PLGA stent seems to overcome the earlier problems of migration and breakage into large particles. 24 Nevertheless, the mechanical properties of the stent need to be improved and tested in a longer follow-up.…”

Critical appraisal of the Spanner&trade; prostatic stent in the treatment of prostatic obstruction

“…They found that the stents were easy to insert and they degraded smoothly over a period of 1–2 months. This stent design was then used in a pilot study along with dutasteride in the treatment of acute urinary retention due to BPH 19. Ten men with acute urinary retention due to BPH were treated in an outpatient setting.…”