Can prostate stents be used to predict the outcome of transurethral resection of the prostate in the difficult cases?
OBJECTIVE
Endoprosthesis has been used to maintain luminal patency in several different diseases and is well established in cardiovascular and gastrointestinal pathologies. The usefulness and application in prostatic pathology and benign prostatic hyperplasia are not as clear. This report reviews the development of overactive bladder in patients with bladder outlet obstruction due to benign prostatic hyperplasia. It also describes a new application of prostatic stents in patients with combined overactive bladder and bladder outlet obstruction.


RESULTS
Over the last few decades, interest has been focused on the pathology of overactive bladder due to bladder outlet obstruction. Persistent outlet obstruction can certainly induce overactivity in some cases. However, the significance of preoperative identification of the latter problem is still an open issue, and it is obviously of vital importance to find instruments to identify parameters of prognostic significance. Different prostatic stents have been used for a variety of purposes. Recent studies have demonstrated that prostatic stents are effective in relieving obstruction and urinary retention. However, the role of prostatic stents in bladder outlet obstruction is still not clear when compared with other minimally invasive options. By using a prostatic stent to simulate transurethral resection of the prostate, the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder has been possible to assess before the operation. However, larger controlled clinical studies are needed to corroborate the value of the test.


CONCLUSIONS
Prostatic obstruction can induce severe overactive bladder in some cases. A prostatic stent to relieve outflow obstruction and to simulate transurethral resection of the prostate decreases the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder because very high risk patients can be excluded from surgery. The stent test indicates that patients who do not leak and experience reduced symptoms when they are relieved of their outlet obstruction can be advised to have a transurethral resection of the prostate.
Knutson
Tomas
T
Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden. tomas.knutson@vgregion.se
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics