Prostatic stent
Encyclopedia
A prostatic stent is a stent
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 is a common condition with a variety of etiologies. Benign prostatic hyperplasia
(BPH) is the most common cause, 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
.
Although a permanent prostatic stent is not a medical treatment, it falls under the classification of a surgical procedure. Placement of a permanent prostatic stent is carried out as an outpatient treatment under local, topical or spinal anesthesia and usually takes about 15–30 minutes.
A temporary prostatic stent can be inserted in a similar manner to a Foley catheter
, requiring only topical anesthesia.
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
. It permits normal bladder and sphincter functioning and can be worn comfortably by patients. The temporary prostatic stent is typically used to help patients maintain urine flow after procedures that cause prostatic swelling, such as brachytherapy, 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, 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 of 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). The main motive for removal of permanent stents is worsening of symptoms even with device fitted. Other reasons have been migration, clot retention, hematuria
, 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 do not consider permanent stents a viable long-term treatment for most men.
Not yet approved in the USA but available in Europe and several other countries are the nickel-titanium stents. These stents place themselves between temporary and permanent stents since they can remain in place for several years and still easily be removed. The reason for this feature is that nickel-titanium becomes super-soft when cooled with cold water.
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
used to keep open the male urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms
Lower urinary tract symptoms
Lower urinary tract symptoms are a common problem affecting approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.-Voiding or obstructive symptoms:*Poor stream*Hesitancy*Terminal dribbling...
(LUTS). Prostatic obstruction is a common condition with a variety of etiologies. Benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH) is the most common cause, but obstruction may also occur acutely after treatment for BPH such as transurethral needle ablation of the prostate
Transurethral needle ablation of the prostate
Transurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
(TUNA), transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
(TURP), transurethral microwave thermotherapy
Transurethral microwave thermotherapy
Transurethral microwave thermotherapy is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia . TUMT provides a one-time efficacious treatment of LUTS due to BPH...
(TUMT), prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
or after radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
.
Classification
There are two types of prostatic stent: temporary and permanent.Although a permanent prostatic stent is not a medical treatment, it falls under the classification of a surgical procedure. Placement of a permanent prostatic stent is carried out as an outpatient treatment under local, topical or spinal anesthesia and usually takes about 15–30 minutes.
A temporary prostatic stent can be inserted in a similar manner to a Foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
, requiring only topical anesthesia.
Food and drug administration approved stents
At the present time, there is one temporary prostatic stent that has received U.S. Food and Drug Administration (FDA) approval. The Spannertemporary 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
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
. It permits normal bladder and sphincter functioning and can be worn comfortably by patients. The temporary prostatic stent is typically used to help patients maintain urine flow after procedures that cause prostatic swelling, such as brachytherapy, 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, 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 of 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
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH), recurrent bulbar urethral stricture
Urethral stricture
A urethral stricture is a narrowing of the urethra caused by injury or disease such as urinary tract infections or other forms of urethritis.-Signs and symptoms:...
(RBUS), or detrusor external sphincter dyssynergia (DESD). The main motive for removal of permanent stents is worsening of symptoms even with device fitted. Other reasons have been migration, clot retention, hematuria
Hematuria
In medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...
, and urinary retention
Urinary retention
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
. 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 do not consider permanent stents a viable long-term treatment for most men.
Not yet approved in the USA but available in Europe and several other countries are the nickel-titanium stents. These stents place themselves between temporary and permanent stents since they can remain in place for several years and still easily be removed. The reason for this feature is that nickel-titanium becomes super-soft when cooled with cold water.
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.
Disadvantages
- They may cause increased urination and limited incontinence.
- They may cause mild discomfort
- They can become dislodged, leading to urinary obstruction or total incontinence.
- They can become infected and can be very difficult to remove.
- Their fixed diameter limits subsequent endoscopic surgical options.
Advantages
- They can be placed in less than 15 minutes in a manner similar to Foley catheter placement.
- They can be easily removed, also in a manner similar to Foley catheter removal.
- They allow the patient to retain volitional voiding.
- Patients prefer a temporary stent to Foley catheter use.
Disadvantages
- A temporary stent will not provide voiding function if the patient does not have a working bladder and external sphincter.
- The stent may cause mild discomfort.
- They may cause urinary frequency which usually subsides after the first 78 hours.
- If the stent is not sized correctly or placed correctly, the patient may experience urinary retention or slight incontinence until the problem is corrected.
See also
- ProstateProstateThe prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
- Prostate cancerProstate cancerProstate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
- Benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
- Urinary retentionUrinary retentionUrinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
- Lower urinary tract symptomsLower urinary tract symptomsLower urinary tract symptoms are a common problem affecting approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.-Voiding or obstructive symptoms:*Poor stream*Hesitancy*Terminal dribbling...