LONG-TERM CLINICAL-RESULTS AND QUALITY-OF-LIFE AFTER INSERTION OF A SELF-EXPANDING FLEXIBLE ENDOURETHRAL PROSTHESIS

Objective To evaluate the safety and efficacy of the Urolume self-expa nding flexible endourethral stent, based on a long-term follow-up, and to determine its role amongst the various modalities of treatment ava ilable for the relief of bladder outlet obstruction (BOG) arising from benign prostatic hyperplasia (BPH). Patients and methods From January 1991 to April 1992, the Urolume wallstent (American Medical Systems, USA) was placed successfully in each of 62 patients (aged 50-89 years) who had significant subjective and objective evidence of BOG. The ste nt was placed as a daycase procedure under general anaesthesia. Pre-op eratively, each patient was assessed fully in an out-patient clinic by symptoms, a flow rate measurement and a rectal examination. Postopera tively patients were assessed using transrectal ultrasonography, cysto scopy, symptoms and now rate measurement, and after 5 years, the Inter national Prostate Symptom Score and satisfaction score were obtained. Results After 5 years, 27 (39%) patients survived and 10 (14%) died wi th their Urolume stent intact; 22 (32%) completed the follow-up and fi ve refused or were lost to follow-up. Day and night-time frequencies a nd flow rates improved continuously. Complete epithelialization occurr ed in 16 of the 22 patients assessed. Of those in whom the Urolume was removed, 20 are alive and five dead. Conclusion The effectiveness of the Urolume in improving symptoms and now rates in patients with BPH w as confirmed. However, the high failure rate arose largely from inexpe rience in selection and deployment. There are no absolute criteria to predict a successful outcome. This study confirms the Urolume as a saf e device. Most patients whose symptoms settled in the first pear maint ained a good now rate and a significant improvement in symptoms for 5 years; their quality of life at the last follow-up was good.