Interstitial laser coagulation and biodegradable self-expandable, self-reinforced poly-L-lactic and poly-L-glycolic copolymer spiral stent in the treatment of benign prostatic enlargement.
OBJECTIVE
Interstitial laser coagulation of the prostate (ILCP) induces necrosis, edema, and an increased risk of postoperative urinary retention. The object here was to evaluate the efficacy, safety, and utility of a new self-expandable self-reinforced (SR) PLGA copolymer(lactic:glycolic ratio 80/20) spiral stent inserted after ILCP to promote voiding. The SR-PLGA stent has a degradation time of 2 to 2.5 months.


METHODS
Fifty men with a mean age of 70.5 years (range 52-85 years), suffering from lower urinary tract symptoms secondary to benign prostatic enlargement underwent ILCP. A suprapubic catheter was inserted, ILCP performed, and an SR-PLGA 80/20 spiral stent inserted on completion of the operation. The suprapubic catheter was removed when voiding commenced. As prophylactic antibiotic, ciprofloxacin was used in a single dose before ILCP, followed by trimethoprim or nitrofurantoin for 2 weeks.


RESULTS
All except three patients started to void on the first postoperative day. In two of the three cases, the stent had moved proximally and had to be relocated, whereafter voiding succeeded. The mean maximum and average flow rates increased, while DAN-PSS-1 symptom score and post voiding residual urine volume decreased statistically significantly. At 2 months, the stent was still intact in the urethra in all except three patients. At 4 months, it had been degraded into small fragments, and at 6 months, it had been completely eliminated. The only exceptions were three patients with an uncalcified piece of the stent in the bladder. Half of the patients had irritative symptoms caused at least partly by ILCP itself; 10% had asymptomatic urinary infection postoperatively.


CONCLUSIONS
The self-expandable SR-PLGA copolymer stent is safe and highly biocompatible. It ensures voiding in the case of temporary obstruction caused by prostatic edema. The degradation time is long enough in all patients to cover the need for postprocedure urinary drainage.
Department of Urology, Tampere University Hospital, Medical School, University of Tampere, Tampere, Finland.
Susanna
S
Laaksovirta
Taina
T
Isotalo
Martti
M
Talja
Tero
T
Välimaa
Pertti
P
Törmälä
Teuvo L J
TL
Tammela
D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D001673:Biodegradation, Environmental; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000517:prevention & control*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology / Q000517:prevention & control*
D001672:Biocompatible Materials; D011098:Polyglactin 910