Self-retaining intraurethral stent: an alternative to long-term indwelling catheters or surgery in the treatment of prostatism.

Abstract

The self-retaining intraurethral coil is a device to stent the urethra in men who have severe urethral obstruction. It allows them to empty their bladders and still remain continent and sexually active. The device can be used in place of long-term indwelling catheters or as an alternative to surgery. During 1 year, we inserted the stent in 26 men who were poor operative risks. The treatment was successful in 20 (77%). All 20 were able to void satisfactorily. Four of the 20 resumed sexual activity, which previously had been prevented by indwelling catheters. Two patients who had delayed prostatic surgery because of fear of impotence were able to empty their bladders properly and to remain sexually active. Three patients subsequently had surgery, two after anticoagulant therapy could be stopped and one after renal function improved. No difficulties caused by the stent were encountered during surgery. Follow-up was for 2-12 months. Four patients who had had the stent in place for 12 months had no difficulties. In 16 of the 18 patients who had indwelling catheters and infected urine before insertion of the stent, sterilization of the urine was obtained after relatively short courses of antibiotic treatment. Short-term complications associated with the stent were incontinence or urinary retention. These were treated by repositioning the stent. Frequency of urination after insertion of the stent either disappeared spontaneously or was treated with anticholinergic drugs. In six patients, frequency was so severe that removal of the stent and insertion of an indwelling catheter were necessary. Slight to mild dysuria occurred immediately after surgery in all patients but eventually disappeared. Our experience suggests that the self-retaining intraurethral stent has considerable promise for the treatment of prostatic obstruction of the urethra.

Late Complications of Prostakath Treatment for Benign Prostatic Hypertrophy

“…The currently accepted treatment of symptomatic BPH is TURP (Lepor, 1989) and it seems unlikely that pharmacological therapy in the immediate future will provide a reduction in the dynamic and static component of BPH comparable to that achieved after TURP. During the last 2 years some reports have confirmed that it is possible to treat urinary retention due to BPH with the Prostakath stent and achieve an unobstructed voiding pattern (Nordling et al, 1989;Harrison and De Souza, 1990;Nielsen et al, 1990;Yachia et al, 1990). This is an attractive non-surgical alternative to permanent catheterisation, especially among patients in operative high risk groups.…”

“…Since Fabian (1980) introduced the intraprostatic stent it has been possible to offer an alternative non-surgical treatment of BPH. Initial experience with the modified Danish spiral (Prostakath) has been promising when compared with permanent catheter treatment (Nordling et al, 1989;Harrison and De Souza 1990;Nielsen et al, 1990;Yachia et al, 1990. We report a late and probably rare complication of the new intraprostatic device: stone formation on the stent.…”

Comparison between First-Generation (Fixed-Caliber) and Second-Generation (Self-Expanding, Large Caliber) Temporary Prostatic Stents

“…4). The technique of insertion of the stents were described elsewhere [2,3], For both stents, after their insertion in order to check the patency of the external sphincter patients were asked to void and stop the stream voluntarily. Patients who could not pass urine were asked to cough.…”

“…Since 1988 we have used two different kinds of intra prostatic stents in place of indwelling catheters: the First one was the Prostakath (Engineers & Doctors A/S, Hornback. Denmark), a First-generation gold-plated stainless- [2], The second stent used was the ProstaCoil (InStent, Inc., Minneapolis, Minn., USA) which is a second-generation self-retaining and self-expanding stent made of nickel-titanium alloy (nitinol) [3].…”

Use of prostatic stents for the treatment of benign prostatic hyperplasia in high-risk patients

“…The outside diameter is 21F and comes in four lengths: 4.5, 5.5, 6.5, and 7.5 cm. Yachia et al [16] reported their experience in 26 men who were poor operative risks. The treatment was successful in 20 (77%), and all 20 men were able to void satisfactorily.…”