Introduction:
Obstruction is most frequently caused by benign prostatic hyperplasia (BPH). However, it can also develop immediately following BPH treatment, such as transurethral needle ablation of the prostate, transurethral resection of the prostate, transurethral microwave thermotherapy, prostate cancer, or radiation therapy. Bladder outflow blockage is a relatively common clinical condition associated with aging and is caused by several benign and malignant prostate illnesses. General or regional anesthesia is not appropriate for high-risk elderly individuals seeking minimally invasive treatment. Unfortunately, individuals who are not suitable for transurethral or laser prostatectomy have few therapy choices other than long-term catheterization and implantation of a prostatic stent (under local anesthesia).
What Are Prostate Stents?
A prostatic stent is a stent that is used to maintain the male urethra open and allow urine to pass in patients who have prostatic blockage and symptoms of the lower urinary tract. Prostatic blockage is a frequent ailment caused by various factors.
Stents are often recommended for men who are not suitable or fit for surgery but can still empty their bladder on their own. For example, older adults who have acute urine retention and cannot undertake more aggressive BPH treatment may benefit from the prostatic stent. These aggressive benign prostatic hypertrophy (BPH) treatment options include prostate excision via transurethral resection (TURP). Instead of an indwelling catheter, prostatic stents are employed.
What Are the Types of Prostate Stents?
There are two types of prostatic stents available:
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Permanent
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Temporary.
Permanent Prostatic Stents: While prostate stents are intended to be a temporary solution for BPH, they can also be permanent. Nowadays, a variety of prostate stents are available. Stents that induce epithelialization and get implanted in the urethra are referred to as epithelializing stents (or permanent prostatic stents).
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Urolume wall stent was the first permanent stent. It was made of stainless-steel superalloy wire woven into a tubular mesh. This braided structure promotes urothelial tissue ingrowth. Epithelization is complete between six to twelve months.
Temporary Prostatic Stents: In comparison to permanent spiral coils, temporary or non-epithelializing prostatic stents have a variety of advantages. They are extensible and constructed of metal as well.
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However, these stents are inserted via the delivery system in their compressed state. Due to this, there is a decreased chance of urethral damage. Stent insertion is a more comfortable procedure that may reduce prostate blockage. They may be a more practical alternative to the urinary catheter, which is now the most widely used technique.
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Temporary prostatic stents are not all the same. These devices come in a variety of generations, including the following:
1) First-Generation: Stents of the first generation were introduced by Fabian. The use of Urospiral stent was made of coiled rust-proof stainless steel with a set caliber and was inserted cystoscopically.
Although early results were encouraging, explantation rates were approximately 40% due to stent lumen migration and encrustation. The Prostakath was a similar fixed-caliber device composed of three components that were gold plated for improved biocompatibility.
Overall, 65 percent of patients achieved success, with no statistically significant difference between these two first-generation metal stents.
2) Second Generation: Devices are more advanced, and materials such as nitinol are more biocompatible. Encrustation (hardening or thickening) is prevented by using biocompatible materials.
Expandable second-generation prostatic stents help avoid migration. A Prostacoil stent is a well-known example of a second-generation prostate stent.
The Prostacoil stent self-expands and was implantable under fluoroscopic supervision and local anesthetic.
In comparison to Prostakah, the Prostacoil stent has a number of advantages, including a bigger caliber that provides more flexibility and a longer duration of indwelling.
3) Third Generation: The creation of thermo expandable stents such as the Memokath stent, a nickel-titanium alloy spiral stent, evolved from refinements to second-generation stents.
One of these components has a floppy structure, while the other has a rigid structure, resulting in a thermosensitive "shape memory."
After inserting Memokath stents in the proper location, they are flushed with warm water at a temperature of 55 to 65°C, which causes them to expand and get anchored in the desired position.
The Memokath will soften and uncoil into a nontraumatic wire that is easy to remove when used with a refrigerator-cold irrigation solution.
4) Fourth Generation: To resolve stent migration issues, researchers developed triangular prostatic Memokath stents.
Initially, these stents were cylindrical. The triangular shape is an excellent match for the form of the prostatic urethral lumen, and no migration occurred nine months after the treatment.
Additional research is required to determine the long-term potential of Memokath stents.
When discussing temporary stents, it's also beneficial to describe materials other than metal. Additional materials used for stents include the following:
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Plastic Stents: The spanner stent is the primary representation, remarkably comparable to the 4 to 6cm Foley catheter. While the stent part of the device is located in the prostatic urethra, the distal anchor is located in the bulbar urethra.
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Biodegradable Stents: Polylactic acid, polyglycolic acid, and copolymers of lactide and glycolide are examples of self-expanding stents. The typical period required for degradation is between two and twelve months. Without the need for removal, these stents decompose to carbon dioxide (CO2) and water.
What Are the Advantages and Disadvantages of Prostate Stents?
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Advantages of Permanent Prostate Stents:
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Bleeding is kept to a minimum both during and after the surgery.
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Procedural time is minimal (15 minutes on average), and a local anesthetic is used.
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Usually does not require overnight hospitalization; patients can return home the following day.
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Advantages of the Temporary Prostatic Stent:
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Procedural time is minimal (15 minutes), and the catheter is similar to a Foley catheter and is simple to remove.
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According to patients, this is a more convenient solution than the Foley catheter.
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Several types of temporary stents are available, including biodegradable stents that do not require removal.
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Disadvantages of Permanent Prostate Stents:
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They may restrict later endoscopic surgical options due to their fixed diameter.
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Possibility of infection, which could make removal more difficult.
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May get dislodged, resulting in complete incontinence or blockage of the urinary tract.
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Mild discomfort.
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Disadvantages of Temporary Prostate Stents:
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Possibility of slight pain.
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If the stent is misplaced or the size is incorrect, patients may develop urine retention or mild incontinence.
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If the external sphincter and bladder are dysfunctional, it does not act as an avoiding mechanism, and it may not reduce voiding symptoms.
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This may increase urine frequency (which tends to go away within 78 hours).
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What Is the Procedure for Prostate Stent Insertion?
The placement of a stent is a minimally invasive operation. The term "minimally invasive" refers to a process that causes little or zero damage to adjacent tissue. Additionally, it does not require a lengthy healing period, unlike other operations. The entire procedure of prostatic stent insertion is uncomplicated. The surgeon inserts a stent into the prostate gland using a flexible cystoscope. A flexible cystoscope is used to examine the interior of a patient's body. This instrument terminates with a stent. The surgeon then inserts it with care.
While doing the procedure, the patient is conscious and does not need general anesthesia, as local anesthesia is enough for minimally invasive procedures. Do not worry; you will feel nothing due to the local anesthetic. To enhance the efficiency and effectiveness of the surgery, the surgeon injects local anesthetic jelly into the urethra so that you will not feel any pain. The prostate is then reached with a flexible cystoscope passed through the urethra. When this occurs, the stent should be positioned. Because the flexible cystoscope has a small camera, the surgeon may view the entire procedure on a monitor. The treatment takes approximately fifteen minutes.
When Can You Resume Your Daily Activities After the Procedure?
Usually, you can go back to your daily routine on the same day, but for some time, the feeling of discomfort and pain while urinating might be present, which usually resolves within a week.
Conclusion:
Every treatment carries a risk of adverse events. The urethral stent placement is not an exception. Adverse effects can vary considerably across individuals. Having said that, you may have discomfort during the first few days following the treatment. Certain males may feel a burning sensation while passing urine. After a few days, these symptoms subside on their own. Consult your physician immediately if you develop fever, or the pain does not go away, and you feel discomfort for a more extended period.
