The UroLume endoprosthesis: a summary of the European and North American experience.
The UroLume Endoprosthesis, although originally developed for endovascular use, has received much interest in recent years for maintaining patency of the male urethra. It is a permanent, flexible, self-expanding device that becomes covered with epithelium and incorporated into the urethral wall. It is being investigated as an effective treatment for recurrent bulbar urethral strictures, BPH, and detrusor-external sphincter dyssynergia. Based on preliminary results, difficult strictures of nontraumatic origin can be treated very effectively with this endoprosthesis; recurrence is a rare event, even with long-term follow-up. This endoprosthesis maintains a large intraluminal diameter in the bulbar urethra, which allows for subsequent catheterization, cystoscopy, and ureteroscopy once epithelialization has occurred. Its placement in the bulbar urethra is straightforward and fast; significant complications are virtually nonexistent. Symptomatic patients with an obstructing prostate gland, in which the prostatic urethra is at least 2.5 cm in length and there is no significant median lobe, can be treated successfully with the UroLume Endoprosthesis. Improvements in obstructive symptoms and peak urinary flow rate approach those of TURP. Many patients, however, do experience irritative voiding symptoms in the immediate postoperative period. If additional studies--that have the proper control arm, a large number of patients, and long-term follow-up--demonstrate this endoprosthesis to be an effective treatment of BPH, its advantages are numerous. They include: 1) placement with the patient under regional anesthesia or with a prostatic block and intravenously administered sedative only; 2) short operating time (10-15 minutes or less) once the procedure is learned; 3) minimal to no intraoperative and postoperative hemorrhage; 4) no indwelling urethral catheter postoperatively; 5) dismissal on the same day or the following morning; 6) minimal convalescence; 7) no effect on the serum prostate-specific antigen (PSA) concentration; and 8) a one-time treatment performed by the practicing urologist. Preliminary studies evaluating the UroLume Endoprosthesis as a treatment for detrusor-external sphincter dyssynergia also have yielded positive results. It is effective in lowering intravesical voiding pressures, allowing for complete bladder emptying, preventing dilatation of the upper tracts, and maintaining stable renal function. It provides for a functional sphincterotomy without the significant complications of hematuria and erectile dysfunction that can result from the traditional endoscopic external sphincterotomy.(ABSTRACT TRUNCATED AT 400 WORDS)
Oesterling
J E
JE
Department of Urology, Mayo Clinic, Rochester, Minnesota.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D011470:Prostatic Hyperplasia / Q000601:surgery*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D013119:Spinal Cord Injuries / Q000150:complications; D014524:Urethral Obstruction / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*