What are prostatic stents? What are the results with prostatic stents?

Prostatic stents are devices that are placed transurethrally and expand to keep the prostatic urethra open. In many ways, they are similar to the coronary artery stents that have gained wide notoriety.

Prostatic stents are most commonly used in older men who are in urinary retention requiring an indwelling urethral catheter and who are not candidates for any

type of invasive therapy. After the stents have been in place for a few months, the mucosa or lining of the urethra grows through them, and they no longer can be seen cystoscopically.

As mentioned, in properly selected patients, prostatic stents can be very useful. The results of one specific type of prostatic stent called the UROLUME appear in Table 15.

Table 15. 36-Month Follow-up North American Urolume Study

Month Post Treatment

Number Patients

Preoperative

Percent Postoperative

Percent Change

Nonretention Cohort

SS (Madsen) decrease

0

95

14

Symptom score

36

95

5

65

Qmax increase

0

95

9 ml/second

Maximum urinary flow rate

36

95

15

67

PVR decrease

0

95

89 ml

Postroid residual

36

95

54

40

Retention Cohort

SS (Madsen)

36

31

Retention

5

Qmax

36

31

Retention

11 ml/second

PVR

36

31

Retention

46 ml

Source: Loughlin, P. 100 Questions and Answers About Prostate Disease. Jones and Bartlett Publishers, LLC, 2007.

What is the role of a permanent indwelling urethral catheter in the treatment of BPH?

Some patients with prostatic obstruction and a weak bladder will not be able to void, regardless of what type of surgical intervention is employed. Some of these patients elect to be managed with an indwelling urethral catheter. The main drawback to an indwelling catheter is infection and irritation. In addition, sometimes the catheter can become plugged with blood or debris and needs to be changed emergently. Most patients with an indwelling urethral catheter have it changed by a visiting nurse at home or in the emergency room or their doctor's office at 1- to 2-month intervals.

An alternative to an indwelling urethral catheter is a suprapubic tube. A suprapubic tube can be placed percutaneously into the bladder through the lower abdominal wall. Many patients find a suprapubic tube more comfortable and easier to manage than a urethral catheter. Either the suprapubic tube or urethral catheter is connected to a drainage bag, which can be worn on the leg or hung on the side of a bed. A suprapubic tube is typically changed by a nurse or physician as is the urethral catheter every 1 to 2 months.

What is the role of a clean intermittent catheterization in the treatment of BPH?

In individuals with BPH who fail to respond to medical therapy, who are not candidates for surgical therapy, and in whom bladder emptying is a problem, clean intermittent catheterization is an alternative to an indwelling foley catheter. If a patient has mobility of his hands and is motivated, he can be easily taught how to perform clean intermittent catheterization. With clean intermittent catheterization, one places a clean, not sterile catheter, into the urethra and passes the catheter into the bladder to drain urine from the bladder. This procedure is performed anywhere from 3 to 6 times per day, depending on how much urine is drained with each catheterization. The catheters are cleaned in between each catheterization and the same catheter may be used for up to a month before changing to a new catheter. If an individual is unable or unwilling to perform self-catheterization, a family member or care-giver can be taught how to perform clean intermittent catheterization.

 
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