CODE: 6.4 - Temporal intraurethral catheter (IUC) as an alternative method in infravesical obstruction treatment
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Tomasz Deja ¹, Tomasz Stachowski ², Zbigniew Kwias ², Ryszard Szpera ¹, Włodzimierz Kowalczyk ¹, Tomasz Piernik ¹, Patryk Gmerek ¹

¹ Oddział Urologii, ZOZ MSWiA w Poznaniu
² Katedra i Klinika Urologii AM w Poznaniu

summary

Introduction. Infravesical obstrucion is the main cause of urine retention and voiding problems. In most cases the obstruction is caused by benign prostatic hyperplasia (BPH) and by urethral strictures (congenital or acquired). In patients among whom pharmacotherapy is no more effective infravesical obstruction has to be removed efficiently. The implantation of an intraurethral catheter can be a satisfying and reasonable solution for many patients, especially for elder ones who are disqualified from operative procedures due to unstable general condition.

Objectives. The aim of the study is to evaluate the application of the temporal intraurethral catheter in patients with infravesical obstruction, especially with BPH disqualified from operative treatment

Materials and methods. In all cases a self-retaining, poliurethane double Malecot intraurethral stent of 50mm length and 16Ch was used. Stents are available in lengths between 25mm and 65mm and sizes 16Ch and 18Ch. Since 2004 the IUC was applied in 13 patients with BPH disqualified from operative procedure due to unstable general condition and in 11 patients after radical prostatectomy - 3 patients after 3D radiotherapy and 3 after adjuvant radiotherapy. Patients' age varied from 57 years to 81 years and in average was 73 years. Average implantation period was 19 weeks (from 13-28 weeks). Patients who had the stents implanted because of other reasons than BPH reported after removal satisfying micturition. Among patients with BPH IUC were implanted up to 6 months and after this time a new stent had to be implanted due to complete urine retention. We present a history o a 90 years old male patient admitted to the hospital with complete urine retention because of BPH, catheterized for the last 7 months. Urinanalysis revealed severe urinary tract infection; the patients also complained of low quality of life. After consultation with an anesthesiologist the patient was disqualified from operative procedure due to unstable general condition and cardiovascular disease. Thus a poliurethane intraurethral stent of 50mm length and 16Ch diameter was placed in the prostatic urethra under local anesthesia

Results. In all patients after the implantation an increase in micturition parameters in uroflowmetry was established. In 7 cases reposition of the device was necessary due to incontinence. Patients who had the IUC implanted because of other reasons than BPH had them removed after 3-4 months while those suffering from BPH had the stents removed and replaced after 6-8 month. The presented 90 years old patient complained about pain in the perineal region only on the next day after the implantation. An improval of the urinary flow and an increase in the quality of life was achieved. Voiding was satisfactory and no significant residual urine volume was measured in ultrasonography. On the third day after implantation the patient was discharged from the hospital in good general condition. After 6 months he was again admitted to the urological ward to change the IUC because of weak urine flow and post voiding residual volume of 100ml of urine. The stent was implanted by using the same technique.

Conclusions. An ideal candidate for the implantation of an IUC seems to be over 80-years old patient, with active lifestyle but in unstable cardiovascular condition suffering from BPH. The implantation of the intraurethral catheter is a worth considering treatment of infravesical obstruction in patients with BPH. Although the implant should not be kept longer than six months it has a lot of advantages. The IUC is easy to apply, has a high success rate and thus can be considered for patients disqualified from operative procedure. It increases definitely the quality of life of the patients and allows them to avoid all complications connected with long term catheterization as infections, urethral stricture and bleedings.