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

Abstract

Benign prostatic hyperplasia (BPH) is a frequent disease in men and a major cause of lower urinary tract symptoms (LUTS). Transurethral resection of the prostate (TURP) or open surgery remains the gold standard of treatment for symptomatic BPH. However, 10% to 15% of patients with BPH cannot undergo surgery due to grave concomitant diseases. For patients presenting with contraindications to surgery or anesthesia, several minimally invasive alternative treatment modalities are available. One such therapeutic alternative is prostatic stenting, which can serve as a temporary or permanent solution for bladder outlet obstruction caused by BPH. Although not a new concept, this is a relatively new treatment modality in the United States, primarily because of the strict regulatory forces governing the use of these devices. Prostatic urethral stents have been widely demonstrated to be safe and effective for the treatment of symptomatic BPH. In addition to being minimally invasive, prostatic stenting is generally rapid, easy to perform, immediately effective, and has a low cost compared with conventional surgical treatment. Prostatic stents are therefore well suited to treat the frail elderly patient who would not be able to withstand the stress of undergoing surgery. This report reviews the current use of prostatic urethral stents in the treatment of high-risk surgical patients with BPH.

Estrogens and bladder outlet obstruction

“…It presents in as many as 70% of men over 70 years [33,34]. Clinically, BPH refers to LUTS, which in turn being associated with BPH may cause BOO [35].…”

Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction

“…26 The authors confirmed that, at 3 years, the change from baseline in IPSS, QoL score, and Qmax was significant. After 36 months of follow up, a 41% rise in Qmax was achieved (mean 10.1 ml/s), the median IPSS was 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and the IPSS QoL was 2 (1-4). 26 Recently, a second-generation implant was introduced, the i-TIND which is comprised of three nitinol elongated struts and an anchoring leaflet and it is again preloaded by crimping it into the delivery system.…”

“…Relative contraindications for intraprostatic stents may be meatal or urethral strictures, urinary tract infections, bladder stones, neurogenic bladder dysfunction, a large median prostatic lobe, a prostatic urethra less than 2 cm long and the presence of bladder neck contracture. 20…”

“…Relative contraindications for intraprostatic stents may be meatal or urethral strictures, urinary tract infections, bladder stones, neurogenic bladder dysfunction, a large median prostatic lobe, a prostatic urethra less than 2 cm long and the presence of bladder neck contracture. 20 Overall, there is a diversity of stents design in terms of length, lumen diameter and material. In addition, the available studies are very small with short follow up, significant attrition rate and different definitions of efficacy.…”

Biomaterials in urology

“…Each of these proprietary biomaterials have been used widely and successfully as biomaterials in the urinary tract, whether it be in the form of urethral catheters or ureteral stents. Metallic biomaterials that are currently used for stenting both the urethra and ureter are composed of superalloy titanium or nickeltitanium mixed alloys [11,12].…”