and Gordon Muir1
Department of Urology, Kings College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
Prostatic stents have been an established part of the urological armamentarium since the 1980s and are available in a variety of forms. First described by Fabian in 1980 , the ‘urological spiral’ was seen as a means by which a patient unfit for surgery could be free of his urethral catheter. Indeed Fabian also discussed the possibility that the spiral could be treated with radioactive material to manage patients with prostate cancer. Advances in bladder neck surgery, particularly GreenLight PVP mean that men with multiple significant co-morbidities, previously deemed unfit and unsuitable for conventional TURP are now being successfully surgically managed. Thus it seems likely that the use of prostatic stents in this population has declined. We could find no public data on this. Sadly little high quality evidence exists for these devices as most publications have been on limited case series, possibly due to relatively small companies without large research budgets developing and distributing the devices.
A number of other implantable surgical devices or minimally invasive procedures exist and are available for men with LUTS. Some of these avoid the significant side effects of dry orgasm and erectile dysfunction: all can be offered to the patient in a day surgery setting, or indeed some in an outpatient or office setting. These devices and procedures offer the option of a minimally invasive procedure to improve the patient’s symptoms rather than ongoing treatment with medication. Consequently, they have the potential of avoiding both the side effects of medication as well as avoiding the permanent sequelae associated with TURP. These newer treatments such as UroLift or iTind have an obvious appeal to sexually active men.
UroLift is performed in a day case setting. The procedure involves using a rigid cystoscope to position an average of four implants (tensioned monofilament sutures, anchored with a metallic tab on the prostate capsule) which are placed under direct vision in the prostatic urethra. These sutures compress the enlarged prostate, open up the prostatic urethra and improve the patients symptoms.
As a guide, between two and four implants are generally used but this is dependent on the appearance during the procedure.
UroLift offers the advantage of being able to be performed in a day case setting, usually without any post-procedure catheter and there is no loss of erectile or ejaculatory function associated with the procedure.
Patients suitable for UroLift are those without an obstructing middle lobe and with a prostate volume of less than 100 ml. As part of the pre-operative evaluation, prospective patients should undergo transrectal ultrasound of the prostate to assess their prostate volume and flexible cystoscopy to assess the anatomy of the middle lobe.