A SELF-EXPANDING PROSTATIC STENT FOR BLADDER OUTLET OBSTRUCTION IN HIGH-RISK PATIENTS

We describe the clinical experience with a self-expanding prostatic st ent used in patients with bladder outlet obstruction and advanced como rbid medical illness. A Gianturco-Zdagger stent was placed in 25 men, including 21 in urinary retention. Patients were followed clinically a nd with serial endoscopy. Mean age was 80.5 years (range 54 to 98). Me an followup was 10.1 months, with a longest followup of 24 months. Spo ntaneous voiding resumed in 20 of 21 patients (95%) with retention, wi th 16 of 21 (76%) demonstrating long-term success. Two patients failed due to stent migration within 1 month. Other complications were limit ed to minor stent incrustations in 2 cases, symptomatic urinary infect ions without fever in 2 and epididymitis occurring 15 months following stent placement in 1. No perioperative cardiovascular complications w ere encountered. Followup endoscopy revealed partial stent coverage by urothelium in 13 of 16 men at 1 month and greater than 90% coverage i n 8 of 13 by 3 months. The high success rate with minimal morbidity ob served suggests that prostatic stents may become the first-line therap y for the medically compromised man with bladder outlet obstruction.