THE BIODEGRADABLE SELF-REINFORCED POLY-DL-LACTIC ACID SPIRAL STENT COMPARED WITH A SUPRAPUBIC CATHETER IN THE TREATMENT OF POSTOPERATIVE URINARY RETENTION AFTER VISUAL LASER-ABLATION OF THE PROSTATE

Objective To evaluate the efficacy and safety of a biodegradable self- reinforced poly-DL-lactic acid (SR-PLA) spiral stent compared with a s uprapubic catheter after visual laser ablation of the prostate (VLAP) in a randomized study. Patients and methods The study comprised 45 pat ients (mean age 67.6 years, range 52-81) with bladder outlet obstructi on caused by benign prostatic hyperplasia who received either a SR-PLA stent (22 patients) and a suprapubic catheter, or a suprapubic cathet er only (23 patients) after undergoing VLAP. The suprapubic catheter w as removed when voiding started. The response to VLAP and the effect o f the stent or catheter were assessed using symptom scores, peak now r ate (Q(max)), post-void residual volume (PVR), stent degradation, infe ction and outcome. Results Voiding started on the first or second day after treatment in 18 (median one day) of 22 patients with a spiral st ent and in eight (median 6 days) of 23 patients with only the suprapub ic catheter. The mean degradation time of the SR-PLA stent was 6 month s; spiral fragments were found in the prostatic urethra or the urinary bladder in 20 of the patients on cystoscopy, Improvements in patient- weighted symptom score, mean Q(max) and PVR were significant in both g roups at the 6 month follow-up. The infection rate increased with the duration of suprapubic catheterization, from 25% (0-3 days) to 44% (>3 days). Stones were seen in two stented patients during the follow-up. Conclusion The SR-PLA spiral stent is safe and effective for the trea tment of post-operative urinary retention after laser therapy. The deg radation time of the stent was unnecessarily long compared with the du ration of prostatic swelling and tissue sloughing after laser therapy, The infection rate depends on the duration of suprapubic catheterizat ion.