Prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia

The condition

2.1 Lower urinary tract symptoms caused by benign prostatic hyperplasia commonly affect men aged over 50. Benign prostatic hyperplasia results from an increased number of stromal and epithelial cells. These cells are typically in the periurethral region of the prostate, with large discrete nodules compressing the urethra. Symptoms include hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention.

Current treatments

2.2 NICE's guideline on lower urinary tract symptoms in men describes current treatment options. Mild symptoms are usually managed conservatively. Medicines such as alpha blockers and 5‑alpha-reductase inhibitors may also be used. If other treatments have not worked, there are several possible surgical options, including transurethral resection of the prostate, transurethral vaporisation, holmium laser enucleation, prostatic urethral lift implant insertion, prostatic artery embolisation and prostatectomy. Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction.

The procedure

2.3 The aim of prostatic urethral temporary implant insertion is to relieve symptoms of benign prostatic hyperplasia by creating new channels in the urethra to increase the flow of urine. The aim of using a temporary implant is to avoid complications from an implant left in place long term.

2.4 Local anaesthesia or light sedation is used. A folded device made from nitinol is inserted into the prostatic urethra under direct visualisation using a cystoscope. The device is opened in the urethra. Over the following days, the pressure applied by struts in the device creates areas of ischaemia in the prostatic urethra and bladder neck. This makes new longitudinal channels through which urine can flow. After 5 to 7 days, lidocaine gel and a flexible silicone extraction catheter are inserted into the urethra and the device is removed. Insertion and removal of the device are both done as day-case procedures.