PTU - Polskie Towarzystwo Urologiczne
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Delayed results of the treatment of bladder outlet obstruction by urethral Urolume stent implantation
Article published in Urologia Polska 2002/55/3.

authors

Andrzej Zbigniew Buczyński
Oddział Neuro-Urologii Specjalistycznego Centrum Rehabilitacji im. Prof. M. Weissa w Konstancinie
Ordynator oddziału: dr Andrzej Zbigniew Buczyński
Dyrektor szpitala: dr Janusz Garlicki

keywords

urethra, subvesical obstruction, urethral stents, UroLume

summary

Introduction. Urological network prostheses have been introduced for a treatment of recurrent urethral strictures by Millroy in 1988, and in Poland - by author of this publication in 1992. The insertion of these prostheses is now a common urological procedure. They are also used in the treatment of of vesico-sphincteral dyssyncrgy and to enable patients with prostate cancer or benign prostatic hyperplasia, in whom an operation can not be performed, to voide urine.
Material and method. UroLume prostheses are produced as a one use only packets, compressed inside of a specific instrument, sterile, ready to implantation, in a five size: from 2 to 4 cm. Double blockade makes possible a change of the prosthesis placement due to repeated compression, and then - proper prosthesis location. The risk of incorrect implantation is low. Complete healing and epithelialisation of the prosthesis persists from 3 to 6 months. Between 1992 and 2001, this method was used in the treatment of 46 patients: 8 of them with benign prostatic nyperplasia, 2 patients with prostate cancer, 25 patients with recurrent urethral strictures, and 11 patients with dyssynergy.
Results. During the follow up of 1.5 to 9 years (mean 4 years), 85% of good results were obtained in all groups of patients. In a dyssynergy group there were 100% good results. In BPH or prostate cancer groups 1 patient required surgery due to complications. In a group with recurrent urethral stricture the highest percent of complications was observed: there were urinary incontinence due to external urethral sphincter location of the prosthesis, and granulation or cicatrization of UroLume lumen. The last of these complications was noted only in patients, in whom total urethral obstruction after serious urethral trauma was treated endoscopically. Three patients needed an artificial urethral sphincter implantation, and 3 other patients needed other surgical treatment.
Conclusions.
1. In patients with prostate cancer or BPH, who can not be qualified to operation, UroLume prosthesis improves the quality of life making bladder catheterisation unnecesary.
2. Prosthesis implantation should be performed in specialistic centres with a good level of experience and a full assortment of prostheses.
3. Patients with serious urethral trauma and complete urethral obstruction have the highest risk of failure of the treatment.

references

  1. 1. Millroy EJG, Chappie CR, Cooper JE i wsp: A new treatment for urethral strictures. Lancet 1988; I: 1424-1427.
  2. 2. Milroy EJG, Chappie CR, Eldin A i wsp: A new stent for the treatment of urethral strictures. Br J Urol 1989: 63; 392-396.
  3. 3. Buczyński AZ: Siatkowe protezy urologiczne. UroLume w leczeniu nawrotowych zwężeń cewki moczowej. Uroi Pol 1993; 46 (4): 300-304.
  4. 4. Chancellor M, Gajewski J, Ackman D i wsp: Long-term follow-up of the North-American multicenter Urolume trial for the treatment of detrusor - external sphincter dyssynergia. J Urol 1999; 161:1545-50.
  5. 5. Chancellor M, Bennett C, Simonean A i wsp: Sphincteric stent versus external sphincterotomy in spinal cord injured men: prospective randomized multicenter trial. J Urol 1999; 161:1893-98.

correspondence

Andrzej Zbigniew Buczyński
Specjalistyczne Centntin Rehabilitacji im. Prof. M. Weissa w Konstancinie Oddział Neur-Urologii
ul. Mierzejewskiego 12
05-511 Konstancin
tel.: (0-22) 754 1783