NEW BPH TREATMENTS, AND HOW TO EVALUATE THEM: LASER PROSTATECTOMY: INTRAURETHRAL STENTS
Stents are tubes, implanted and left in place to hold open a space that otherwise would collapse or be compressed—in this case, in the urethra where it’s choked by the prostate. The tubes are not visible and can be implanted quickly, in outpatient surgery that lasts about fifteen minutes. They are a good option for older men who are too ill to be eligible for other procedures. They’re also a major addition to the meager range of alternatives formerly available to these men. Until recently, this consisted mainly of bladder catheters, left in place indefinitely, whose presence in the body over time leads to urinary tract infection, sepsis, bladder stones, and even kidney damage.
With the stents, there’s no need for a urinary catheter, and the procedure can be performed under local anesthesia. There’s hardly any bleeding during or after the operation, minimal recovery time, and sexual function is not impaired.
The stents come in several models. The newest ones are made of nickel-titanium alloys, which are flexible and have an intrinsic memory—they expand when heated, and become flaccid and increasingly malleable when cooled. They’re easy to install and, when positioned correctly, will expand when irrigated with warm water. If it becomes necessary to remove them, these stents can be irrigated with cold water, which cause them to contract and become malleable again. They’re designed to be incorporated into the body, to meld with the epithelial tissue lining the urethra—a feat that takes the body about three to six months to accomplish, as the tissue knits a thin blanket of cells to cover the tube. Why is this coverage necessary? It’s like greasing a pan before cooking so nothing will stick to it—except the “grease” here is the body’s own cells. (During this time, bicycle riding and other activities that put pressure on the perineum should be avoided.)
One drawback of the stents is that no prostate tissue is removed and sent to a pathologist for examination. Also, the possibility exists that, over time, the epithelial tissue lining the urethra could do such a good job of covering the tube that it might overgrow the stent, and surgery to correct this may be needed. Stents aren’t a good option for men with BPH in the middle lobe; the site of enlargement interferes with the coverage of epithelial cells.
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