Prostatic stent

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Prostatic stent for treatment of BPH
Classification and external resources
Prostatic stent use in the treatment of BPH
ICD-10 N40.
ICD-9 600
DiseasesDB 10797
eMedicine med/1919 
MeSH D

A Prostatic stent[1] is used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and Lower urinary tract symptoms (LUTS). Prostatic obstruction[2] is a common condition with a variety of etiologies. Benign prostatic hyperplasia (BPH) is the most common cause[3], but obstruction may also occur acutely after treatment for BPH such as Transurethral needle ablation of the prostate (TUNA), Transurethral resection of the prostate (TURP), Transurethral microwave thermotherapy (TUMT), Prostate cancer or after radiation therapy.

Contents

[edit] Classification

Although a prostatic stent is not a medical treatment, it falls under the classification of a surgical procedure[4]. Stenting is carried out as an outpatient treatment under local, topical or spinal anesthesia and usually takes about 15-30 minutes.

There are two types of prostatic stent: temporary and permanent.

[edit] Food and drug administration (FDA) approved stents

At the present time, there is one temporary prostatic stent that has received FDA approval[5]. The Spanner[1] temporary prostatic stent maintains urine flow and allows natural voluntary urination. The prostatic stent is a completely internal device and can be inserted and removed as easily as a Foley catheter[6]. It permits normal bladder and sphincter functioning and can be worn comfortably by patients[7]. The temporary prostatic stent is typically used to help patients maintain urine flow after procedures that cause prostatic swelling, such as bracytherapy, cryotherapy, TUMT, TURP. It has also become an effective differential diagnostic tool for identifying poor bladder function separate from prostatic obstruction.

Permanent stents are often metal coils[8], which are inserted into the male Urethra. The braided mesh is designed to expand radially, applying constant gentle pressure to hold open the sections of the urethra that obstruct the flow or urine. The open, diamond-shape cell design of the stent allows the stent to eventually become embedded in the urethra, thus minimizing the risk for encrustation and migration. Permanent stents are used to relieve urinary obstructions secondary to benign prostatic hyperplasia (BPH), recurrent bulbar Urethral stricture (RBUS), or detrusor external sphincter dyssynergia (DESD)[9]. The main motive for removal of permanent stents is worsening of symptoms even with device fitted. Other reasons have been migration, clot retention, haematuria, and urinary retention. The only FDA approved permanent stent is the Urolume. Usually, permanent stents are used only for men who are unwilling or unable to take medications or who are reluctant or unable to have surgery. Most doctors don't consider permanent stents a viable long-term treatment for most men.[10]

[edit] Advantages and disadvantages to prostatic stenting

[edit] Advantages

  • They can be placed in less than 15 minutes under regional anesthesia.
  • Bleeding during and after surgery is minimal.
  • The patient can be discharged the same day.

[edit] Disadvantages

  • They may cause increased urination and limited incontinence.
  • They may cause mild discomfort

[edit] See also

[edit] References

  1. ^ http://www.touchbriefings.com/pdf/33/gs031_p_16dijk.pdf
  2. ^ Guidelines on Benign Prostatic Hyperplasia. European Association of Urology. http://www.uroweb.org/fileadmin/user_upload/Guidelines/BPH.pdf | page 36 | 12 September 2006
  3. ^ Enlarged prostate gland - treatment, symptoms and cause
  4. ^ Benign Prostatic Hyperplasia (BPH)/Enlarged prostate - Medical Treatment - urologychannel
  5. ^ http://www.fda.gov/cdrh/pdf6/p060010b.pdf
  6. ^ The Journal of Urology vol. 177, , March 2007, Neal D Shore et al
  7. ^ Corica AP, Larson BT, Sagaz AG et al. A novel temporary prostatic stent for the relief of prostatic urethral obstruction. BJU Int 2004;93:346-48
  8. ^ UroToday - European Urology - The Bell-Shaped Nitinol Prostatic Stent in the Treatment of Lower Urinary Tract Symptoms: Experience in 108 Patients
  9. ^ DESD Resource Page
  10. ^ Enlarged prostate (BPH) guide - MayoClinic.com