Bladder outlet obstruction (BOO) is most common in aging men. It is often caused by BPH. According to the National Institutes
of Health, BPH affects more than 50% of men over age 60 and as many as 90% of men over the age of 70 years.
BOO can have many other causes, including bladder stones, bladder tumors, pelvic tumors (eg, prostate, rectum), and urethral
strictures. The symptoms of BOO may vary, but can include abdominal pain, continuous feeling of a full bladder, urinary hesitancy,
urgency/frequency, acute urinary retention (AUR), dysuria, weak stream, and urinary tract infection.
Treatment of BOO depends on the cause of the problem. For most cases, a Foley catheter and/or clean intermittent self-catheterization
will relieve the obstruction temporarily. Occasionally, a suprapubic catheter is employed to drain the bladder. Long-term
treatment of BOO usually involves surgery. However, medical treatment options are available for many of the diseases that
cause BOO.
Figure 1
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In 2006, the FDA approved The Spanner (AbbeyMoor Medical, Parkers Prairie, MN), a temporary, disposable prostatic stent that
is inserted and removed in the office (figure 1). Approval was based on studies showing the stent to be safe and effective
in men with BOO after minimally invasive treatment for BPH (J Urol 2007; 177:1040-6; Urology 2008; 71:873-7).
Series Editor Gerald L. Andriole, MD, is professor of surgery and chief, division of urologic surgery, Washington University
School of Medicine, St. Louis. He is also the director of the Urologic Research Center at Barnes-Jewish Hospital.
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This article will help urologists to quickly gain experience and confidence in temporary prostatic stenting and to incorporate
use of the stent into their clinical practice. We report our early experience with this device in diverse patient populations,
provide answers to the most commonly asked technical questions, and outline patient information that encourages realistic
expectations and acceptance.
Advantages of temporary stenting
Temporary prostatic stenting provides a rapid, easily performed alternative to traditional indwelling urethral catheterization,
clean intermittent self-catheterization, or the placement of a suprapubic tube (Eur Urol 2006; 49:353-9; Van Dijk MM, de la Rosette JJMCH. Business Briefing: European Pharmacotherapy 2003, pgs. 50-3). It alleviates
BOO and reduces the clinical risk of AUR (Curr Urol Rep 2003; 4:282-6). In addition, quality of life is markedly improved by restoring volitional voiding, decreasing lower urinary
tract symptoms (J Urol 2007; 177:1040-6; Urology 2008; 71:873-7), and lowering the potential risk of a complicated urinary tract infection (J Endourol 2006; 20:272-7).
Table 1
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The stent has been shown to be associated with few reports of migrations, expulsions, or clinically significant encrustation,
and no increase in urethral and bladder irritation or urinary tract infection. It thus satisfies the majority of criteria
for successful clinical performance of a prostatic stent (table 1) (Cockett AT, Aso Y, Denis L, et al. Recommendations of
the International Consensus Committee concerning: 4. Treatment recommendations for Benign Prostatic Hyperplasia. Proceedings
of the Third International Consultation on Benign Prostatic Hyperplasia. Monaco, 26-28 June 1996; pgs. 625-50). Prior to development
of this product, the only FDA-approved prostatic stent was a permanent device indicated for use in high surgical-risk patients
with significant comorbidities (Eur Urol 2006; 49:353-9; Curr Urol Rep 2003; 4:282-6; J Urol 1996; 155:1956-8; J Endourol 1997; 11:473-5).
Practice Tools
