Objective: To evaluate the medium-term and long-term results of treatment of symptomatic benign prostatic hyperplasia (BPH) by permanent transprostatic urethral stenting in high surgical risk patients.
Materials and methods: Single-centre retrospective study on 19 consecutive patients with a mean age of 79.5 years (range: 61-96) treated by nitinol permanent urethral stent (Boston Scientific Corp.) from December 1995 to July 2006 for bladder neck obstruction. All patients presented a major contraindication (ASA III or IV) to immediate conventional surgical management. Stenting was performed under endourethral Xylocaine gel local anaesthesia. Fourteen patients presented acute urinary retention and 4 had chronic obstructive renal failure. One patient with an indwelling catheter had a history of recurrent acute prostatitis. The functional results were assessed by resumption of voiding, determination of post-voiding residual volume, serum creatinine and presence or absence of symptomatic urinary tract infection. The anatomical assessment was performed by voiding and retrograde cystourethrography and urethral endoscopy.
Results: This series of 19 patients had a mean follow-up of 20 months (1-62). No intraoperative complication was observed. Resumption of voiding was achieved immediately postoperatively in 18 patients. One patient required more prolonged urinary drainage before voiding was restored. No cases of stent migration were observed. Postoperative serum creatinine was stable. Post-voiding residual volume was less than 100 ml in fifteen patients and less than 200 ml in four patients. One patient was explanted.
Conclusion: The treatment of bladder neck obstruction by permanent urethral stenting is an alternative to surgery for patients considered to be temporarily or permanently inoperable. This indication remains exceptional, but should be kept in mind in view of the satisfactory medium-term results to associated with a low morbidity for a procedure performed exclusively under local anaesthesia.