Aquablation versus TURP: 5-year outcomes of the WATER randomized clinical trial for prostate volumes 50-80 mL.

INTRODUCTION: To report the 5-year efficacy and safety of Aquablation compared with transurethral resection of the prostate for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with prostate volumes 50-80 mL. MATERIALS AND METHODS: In a large double-blinded, multicenter, and prospective randomized controlled trial, 96 randomized men with 50-80 mL prostates who underwent Aquablation or transurethral prostate resection were prospectively identified for subgroup analysis. Follow up was performed for up to 5 years. The primary efficacy endpoint was the reduction in International Prostate Symptom Score (IPSS) at 6 months. The primary safety endpoint was the occurrence of Clavien-Dindo (CD) postoperative complications grade 1 persistent and grade 2 or higher at 3 months. RESULTS: Both groups had comparable baseline characteristics. Reduction in IPSS score was significantly higher in the Aquablation group across 5 years of follow up (-14.1 vs. -10.8, p = 0.02). The Aquablation group achieved a significantly lower rate of CD1P and CD2 or higher events at 3 months follow up (risk difference of -23.1%). Among recorded adverse events, de novo postoperative ejaculatory dysfunction was notably lower in Aquablation (risk difference of -21.9%), while the risk of bleeding remained similar after 6 months. The surgical and medical retreatment rate at 6 months was also lower in Aquablation (risk difference of -14.4%). CONCLUSIONS: In the 50-80 mL prostate volume subgroup, Aquablation yields superior long-term symptom relief and lower complication rates than standard transurethral resection, with notably lower rates of ejaculatory dysfunction. This further supports the adoption of Aquablation for men with medium-sized prostates.

Chemokine therapy for anal sphincter injury in a rat model: a pilot study.

INTRODUCTION AND HYPOTHESIS: To determine whether delayed administration of CXCL12 alters anorectal manometric pressures and histology in rats following anal sphincterotomy compared to primary surgical repair alone. METHODS: Adult female rats were divided into three groups: A, a control group that did not undergo surgery; B, anal sphincterotomy with primary surgical repair; C, anal sphincterotomy with primary surgical repair and intra-sphincteric injection of CXCL12 at 6 weeks post-injury. All rats underwent anal manometry measurements at baseline and at 6 and 12 weeks post-injury. Histologic analysis of the anal sphincters was also performed. RESULTS: At baseline and 6 weeks, there were no statistically significant differences among D, Tmax and P∆ of Groups A, B and C. At 12-week manometry, the total duration of contractions on anal manometry was significantly less in Group C compared to Groups A and B (3.65, 5.5, 5.3 p < 0.01) as was time to peak of contraction at 12 weeks (1.6, 2.1, 3.1, p < 0.01); however, group C had a significantly higher P∆ at 12 weeks compared to Groups A and B (2.25, 1.4, 0.34, p < 0.01). There were no statistically significant differences in the ratio of muscle to collagen at the site of injury; however, muscle fibers were significantly smaller in group C and less per bundle than the other groups. CONCLUSIONS: Administration of chemokine therapy at 6 weeks post-repair using CXCL12 enhanced the magnitude of anal sphincter contractions in a rat model of anal sphincter injury but decreased overall duration of contraction. Increased anal sphincter contraction magnitude was not explained by histologic differences in explanted specimens.

Evaluation of Clinical Use and Cost-Effectiveness of a Flexible Cystoscope System with a Disposable Sheath: A Randomized Clinical Trial.

INTRODUCTION: Flexible cystoscopy is routinely performed as an outpatient procedure. The use of disposable sheaths can increase cystoscope life span and reduce staff costs. The primary end point of this study was to evaluate procedure related discomfort and pain, physician maneuverability, residual bioburden and reprocessing time. The secondary end point was to analyze the cost-effectiveness of a flexible cystoscope with a disposable sheath compared to a standard flexible cystoscope. METHODS: This randomized clinical trial was performed with women older than 18 years, with intact cognition and 7 days antibiotic-free who were referred to outpatient clinic for cystoscopy. Patients underwent cystoscopy with a standard flexible cystoscope or flexible cystoscope with disposable sheath. Urinalysis and culture were performed before and 14 days after cystoscopy. Patients filled out a pain/discomfort visual analog scale. Physicians filled out a 5-point Likert scale for the elements of ease of insertion, manipulation, optical quality and overall use. Reprocessing time and costs were compared between both cystoscopes. RESULTS: A total of 60 patients were included in the study, comprised of 30 who underwent standard flexible cystoscopy and 30 who underwent flexible cystoscopy with a protective sheath. Patient discomfort/pain was equivalent in both groups. The Likert scores were similar except for ease of insertion, which was higher with protective sheaths (p <0.02). Protective sheaths were associated with lower reprocessing time and costs (p <0.001). CONCLUSIONS: The use of protective sheaths effectively reduced procedure and staff related costs without causing any additional patient discomfort or pain. The learning curve of the sheathed scope may explain the difference reported by physicians regarding the ease of insertion.

Peripartum Perineal Hernia: A Case Report and a Review of the Literature.

OBJECTIVES: This article reviews the literature for the management and repair of perineal hernias and presents a previously undescribed case of perineal bladder herniation after intrapartum pubic symphysis rupture. METHODS: A review of the literature was completed through the PubMed database using the search terms "bladder," "canal of Nuck," "labial hernia," "gynecology," "hernia," "obstetrics," "perineal hernia," "postpartum," "pubic diastasis," "pubic symphysis," "vaginal delivery," "symphyseal rupture," and "symphyseal separation." The electronic medical record for the patient was reviewed and used with the consent of the patient. RESULTS: There were no reports of peripartum perineal hernias in the English language literature on human subjects. Literature review with the previously mentioned search terms demonstrated that there is not a standardized approach to repair given the rarity of these defects. There are data to support the use of mesh as opposed to primary repair but no data to support abdominal versus perineal versus combined approach. We describe a successful repair of a complicated peripartum perineal hernia using a combined abdominal-perineal approach with mesh. CONCLUSIONS: Obstetric trauma is a previously unreported cause of perineal hernias. Perineal hernias are rare conditions that must be considered in any patient who presents with a bulging perineal mass. Puerperal pubic symphysis rupture can lead to a large bladder hernia. Our combined abdominal-perineal approach of repair resulted in minimal perioperative morbidity and short-term resolution of the hernia.

Vaginal Mesh Exposure Presentation, Evaluation, and Management.

INTRODUCTION: According to FDA, in 2010, approximately 300,000 women underwent surgical procedures in the USA to repair pelvic organ prolapse and approximately 260,000 underwent surgical procedures to repair stress urinary incontinence. From 560,000 surgeries, synthetic mesh was used in one out of three, and three out of four were performed transvaginally. The incorporation of mesh into pelvic organ prolapse repair has improved the long-term surgical anatomical outcomes and lower recurrence rates. However, vaginal mesh placement is associated with risks such as vaginal mesh erosion, exposure, and infection. OBJECTIVE: The main objectives of this study were to review the literature regarding vaginal mesh exposure and, based on the literature evidences, develop an algorithm to help urologists and gynecologists to promptly recognize the problem and treat it effectively with minimal additional morbidity. RESULTS: Diabetes mellitus, advanced age, smoking, concomitant hysterectomy, surgeon's experience, surgical technique, and proper training in pelvic organ reconstructive procedures have all been shown to be risk factors for vaginal mesh exposure. The clinical presentation of mesh exposure varies and the management depends upon the extent and location of exposure, associated patient bother, voiding complaints, and involvement of adjacent viscera if any. Once vaginal mesh exposure is diagnosed, it would be pragmatic to rule out simultaneous perforation/erosion into the bladder/urethra or bowel and associated collection if any. CONCLUSIONS: The exponential increase in the number of mesh-related complications is related mainly to a lack of surgeon's experience and proper training in reconstructive pelvic surgeries as well as availability of easy-to-handle kits. Despite improvements in short- and long-term outcomes since the introduction of mesh in pelvic surgeries, the incidence of post-operative complications remains elevated. We developed an algorithm to facilitate prompt recognition and treatment of vaginal mesh exposure aiming to help urologists and gynecologists to achieve better outcomes and success rates.

The management of prostatic obstruction with urethral stents.

INTRODUCTION: Elderly men with multiple comorbidities may be unfit to undergo surgical management of benign prostatic obstruction (BPO). Permanent and temporary prostatic stents have been developed as an alternative to chronic indwelling catheters in men unfit for surgery. MATERIALS AND METHODS: Herein we review the past and present literature on the role and effectiveness of prostatic stents in the treatment of BPO. RESULTS: Permanent prostatic stents have largely been abandoned in North America due to unfavorable outcomes and improved technologies to allow for treatment of BPO. Currently, the temporary Spanner stent is the only available stent on the market, but its effectiveness has mostly been documented for temporary relief of tissue edema following minimal invasive ablative treatments for BPO. CONCLUSIONS: The advent of well-tolerated surgical treatments for BPO (KTP laser vaporization, bipolar TURP, urethral lift devices) has diminished the need for permanent prostatic stents. The temporary Spanner stent is an alternative to urethral catheter, but requires adequate detrusor function and can cause irritative symptoms.

Evidence-based outcomes for mesh-based surgery for pelvic organ prolapse.

PURPOSE OF REVIEW: In light of all the recent controversy regarding the use of synthetic mesh for pelvic organ prolapse, we did a retrospective review of the evidence-based outcomes and complications for its use. RECENT FINDINGS: A total of 18 of the most recent studies in the last 5 years were selected. Studies selected were prospective randomized or quasi-randomized controlled trials that included surgical operations for pelvic organ prolapse for this review. Additionally, Cochrane review and meta-analysis of outcomes and complication were also analyzed. In terms of outcomes, the definition of successful surgery is currently being debated. Synthetic mesh provides superior anatomical and subjective cure rates compared with native tissue repair. Success rates varied greatly depending on the nature of prolapse and surgical approach. Furthermore, recurrence rates for mesh-based surgery are significantly lower than that for native tissue repair. The main unique complication of mesh is exposure and was reported in a mean of 11.4% of patients, with 6.8% of patients requiring surgical partial excision of mesh. SUMMARY: Mesh significantly improves anatomical outcomes with sacrocolpopexy and vaginal repair. Mesh does create the unique complication which can be reduced with training and proper patient selection. Further development of better materials is vital rather than reverting to tissue-based repair. Ultimately, the decision to use mesh should be based upon a patient's personal goals and preferences after an informed conversation with her physician.

Correlation of gene expression with bladder capacity in interstitial cystitis/bladder pain syndrome.

PURPOSE: Interstitial cystitis and bladder pain syndrome are terms used to describe a heterogeneous chronic pelvic and bladder pain disorder. Despite its significant prevalence, our understanding of disease etiology is poor. We molecularly characterized interstitial cystitis/bladder pain syndrome and determined whether there are clinical factors that correlate with gene expression. MATERIALS AND METHODS: Bladder biopsies from female subjects with interstitial cystitis/bladder pain syndrome and female controls without signs of the disease were collected and divided into those with normal and low anesthetized bladder capacity, respectively. Samples then underwent RNA extraction and microarray assay. Data generated by these assays were analyzed using Omics Explorer (Qlucore, Lund, Sweden), GeneSifter® Analysis Edition 4.0 and Ingenuity® Pathway Analysis to determine similarity among samples within and between groups, and measure differentially expressed transcripts unique to each phenotype. RESULTS: A total of 16 subjects were included in study. Principal component analysis and unsupervised hierarchical clustering showed clear separation between gene expression in tissues from subjects with low compared to normal bladder capacity. Gene expression in tissue from patients with interstitial cystitis/bladder pain syndrome who had normal bladder capacity did not significantly differ from that in controls without interstitial cystitis/bladder pain syndrome. Pairwise analysis revealed that pathways related to inflammatory and immune response were most involved. CONCLUSIONS: Microarray analysis provides insight into the potential pathological condition underlying interstitial cystitis/bladder pain syndrome. This pilot study shows that patients with this disorder who have low compared to normal bladder capacity have significantly different molecular characteristics, which may reflect a difference in disease pathophysiology.

Transcriptome analysis of bladder biopsy from interstitial cystitis/bladder pain syndrome patients.

Interstitial cystitis and bladder pain syndrome (IC/BPS) are terms used to describe a heterogeneous chronic pelvic and bladder pain disorder. Despite its significant prevalence, the disease etiology is not well understood and providing diagnosis and treatment can be challenging. In our study, published recently in the Journal of Urology (Colaco et al., 2014), we describe the use of microarrays as a tool to characterize IC/BPS and to determine if there are clinical factors that correlate with gene expression. This data-in-brief article describes the methodology for that study, including data analysis, in further detail. Deposited data can be found in the Gene Expression Omnibus (GEO) database: GSE57560.

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review.

We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.

Developing selection criteria for prostate-sparing cystectomy: a review of cystoprostatectomy specimens.

OBJECTIVES: To determine risk factors for prostate pathology, which may serve as guidelines for identifying patients who may be inappropriate for prostate-sparing cystectomy for treatment of transitional cell cancer of the bladder. METHODS: After obtaining Institutional Review Board approval, we reviewed the clinical and pathologic data from consecutive men treated with radical cystoprostatectomy (RCP) between January 2003 and September 2008. We reviewed the RCP pathology for prostatic involvement by transitional cell carcinoma (PI-TCC) as well as presence of prostate cancer (PCa). Univariate analysis was used to test for association of clinical parameters with prostatic involvement in RCP specimens. RESULTS: A total of 96 patients with a median age of 67 (interquartile range: 47, 79) underwent RCP between January 2003 and September 2008. PI-TCC was present in 24 patients (25%) of which 6 (25%) had carcinoma in situ (CIS) only and 18 (75%) had stromal invasion. We identified PCa in 40 patients (42%). CIS (odds ratio, 3.2, P = .018) and tumor situated at or below the trigone (odds ratio, 3.3, P = .046) at the pre-RCP transurethral bladder tumor resection were associated with PI-TCC. CONCLUSIONS: PI-TCC and PCa are common findings at RCP. The location of the bladder tumor situated at or below the trigone and the presence of CIS at transurethral bladder tumor resection is associated with increased risk for PI-TCC and should be considered at least relative contraindications for prostate-sparing cystectomy. A thorough investigation for PCa should be conducted for all possible candidates.

Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons.

PURPOSE: With the exponential growth of robotic urological surgery, particularly with robot assisted radical prostatectomy, guidelines for safe initiation of this technology are a necessity. Currently no standardized credentialing system exists to our knowledge to evaluate surgeon competency and safety with robotic urological surgery performance. Although proctoring is a modality by which such competency can be evaluated, other training tools and guidelines are needed to ensure that the requisite knowledge and technical skills to perform this procedure have been acquired. We evaluated the current status of proctoring and credentialing in other surgical specialties to discuss and recommend its application and implementation specifically for robot assisted radical prostatectomy. MATERIALS AND METHODS: We reviewed the literature on safety and medicolegal implications of proctoring and the safe introduction of surgical procedures to develop recommendations for robot assisted radical prostatectomy proctoring and credentialing. RESULTS: Proctoring is an essential mechanism for robot assisted radical prostatectomy institutional credentialing and should be a prerequisite for granting unrestricted privileges on the robot. This should be differentiated from preceptoring, wherein the expert is directly involved in hands-on training. Advanced technology has opened new avenues for long-distance observation through teleproctoring. Although the medicolegal implications of an active surgical intervention by a proctor are not clearly defined, the role as an observer should grant immunity from malpractice liability. CONCLUSIONS: The implementation of guidelines and proctoring recommendations is necessary to protect surgeons, proctors, institutions and, above all, the patients who are associated with the institutional introduction of a robot assisted radical prostatectomy program. With no current guidelines we anticipate this article will serve as a catalyst of interorganizational discussion to initiate regulatory oversight of surgeon certification and proctorship.

The science behind biomaterials in female stress urinary incontinence surgery.

Female stress urinary incontinence, while not life threatening, can present with various social and economic implications. Biomaterials, primarily synthetic, are often utilized to augment surgical correction. Repair with biomaterials involves midurethral support to function against weakened connective tissue caused by injury, abnormal collagen metabolism, or genetic predisposition. Even though efficacy rates are high, the potential for complications, such as erosion, are great without comprehension of inherent characteristics of each graft material. Low-weight, macroporous, monofilament synthetic grafts and noncross-linked biologic grafts are examples of biomaterials that implant reasonably well with host tissue. This paper reviews the justification for biomaterial use, host reaction, and the various parameters of natural and synthetic grafts.

A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy?

OBJECTIVES: To determine whether there is an oncologic benefit of adjuvant bacillus Calmette Guérin (BCG) after resection of upper tract transitional cell carcinoma (UTTCC). METHODS: A total of 133 renal units (RU) treated by percutaneous resection for UTTCC between 1985 and 2005 were retrospectively analyzed. Forty-four RU were excluded because of carcinoma in situ, high grade/stage, metastatic disease present at initial presentation, and/or the patient could tolerate loss of RU. Eighty-nine RU treated primarily by percutaneous resection were then analyzed. Fifty RU received adjuvant BCG therapy 2 weeks after endoscopic management for a total of 6 courses. Recurrence was defined as a positive biopsy result after the third-look nephroscopy. Progression of disease was assessed at time of recurrence and defined as an increase in grade/stage of disease. RESULTS: Mean age (+/- SD) of 89 RU was 70.9 +/- 11.1 years. Overall follow-up was 61.1 + 54.8 months. Grade distribution was 56.2% (50 of 89) and 43.8% (39 of 89) for low- and high-grade disease, respectively. There was no statistical difference with regard to tumor grade or stage between treated and nontreated groups (P > .05). Recurrence, time to recurrence, and progression of disease among RU treated with BCG were subselected by grade and compared with the corresponding nontreated group. Statistical significance between any of the treated and nontreated groups was not demonstrated (P > .05). CONCLUSIONS: Our data demonstrate that there is no overall oncologic benefit in the administration of adjuvant BCG with regard to disease recurrence, interval to recurrence, and progression of disease in the treatment of UTTCC.

High-energy transurethral thermotherapy with CoreTherm approaches transurethral prostate resection in outcome efficacy: a meta-analysis.

BACKGROUND AND PURPOSE: Minimally invasive office-based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. We conducted a meta-analysis of published randomized controlled trials that compared high-energy transurethral microwave thermotherapy (HE-TUMT) with transurethral resection of the prostate (TURP) to compare subjective and objective outcomes. MATERIALS AND METHODS: A literature search using Pub-Med was conducted to obtain all published data on HE-TUMT and all randomized controlled trials that compared HE-TUMT with TURP. Data were analyzed focusing on the pretreatment and posttreatment end points of the International Prostate Symptom Score(IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR). A meta-analysis was conducted, and data were stratified with respect to the type of HE-TUMT machinery used. RESULTS: A total of 458 patients were studied. Differences in IPSS, Q(max), and PVR from current trials that compared TURP with HE-TUMT are best evaluated at 1-year follow-up. At this time point, changes in Q(max) (P < 0.001), IPSS (P = 0.01), and PVR (P = 0.02) are more significant if TURP is the management mode. HE-TUMT with the CoreTherm() device demonstrates the most significant improvements in subjective and objective criteria that approximate outcomes with TURP (Figs. 1-3). CONCLUSIONS: A meta-analysis of current randomized controlled trials that compared TURP with HE-TUMT demonstrates more significant changes in Q(max), IPSS, and PVR when TURP is used to manage symptomatic BPH. Despite these statistical differences, stratified data demonstrate that current HE-TUMT machinery is more effective than previously used lower-energy machinery, especially at objective end points. This is most evident when the CoreTherm device is used. These findings, coupled with the decreased costs and morbidity associated with HE-TUMT, support this treatment as a reasonable alternative to TURP.

Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin.

OBJECTIVES: To assess SAPE as an alternative treatment option in patients with refractory hematuria of prostatic origin. METHODS: A retrospective analysis of charts from 10 patients. Two patients were excluded from the analysis because of severe atherosclerotic disease that prevented selective angiography of the pelvic vasculature. Therefore, 8 patients, mean age of 78.3 +/- 7.1 years with a history of refractory hematuria of prostatic origin were analyzed. All patients failed conventional therapy. The selective embolization procedures were performed between 2000 and 2006. Success was monitored with postembolization angiography and cessation of hematuria clinically. RESULTS: Of the 8 patients, 6 had a history of adenocarcinoma of the prostate (mean Gleason Grade 7, range 5 to 9); 4 were previously treated with external beam radiation. The remaining patient's histories were consistent with benign prostatic hypertrophy. SAPE was technically successful in all 8 patients and resulted in immediate cessation of gross hematuria. Mean follow-up postembolization was 20.0 months (range 1.5 to 86.3 months). One patient had gross hematuria develop 14 months after embolization that was attributed to a bladder tumor recurrence. One patient with T4 prostate cancer had a rectovesical fistula develop 1 month after embolization. CONCLUSIONS: SAPE results in cessation of refractory gross hematuria in patients with benign prostate hyperplasia and patients with prostate cancer previously treated with radiotherapy. SAPE may be considered an effective treatment for gross hematuria in patients with refractory hematuria regardless of the cause (radiation, cancer and/or hyperplasia).

Laparoscopic versus open radical nephrectomy for xanthogranulomatous pyelonephritis: Contemporary outcomes analysis.

BACKGROUND AND PURPOSE: Early experience with laparoscopic nephrectomy for xanthogranulomatous pyelonephritis (XGP) was associated with high conversion and complication rates. We describe our institution's experience with this procedure compared with a contemporary cohort of patients with XGP treated by open nephrectomy. PATIENTS AND METHODS: Retrospective review of surgical pathology reports from radical nephrectomies at our institution between 1995 and 2005 yielded a diagnosis of XGP in 12 patients, 6 of whom had undergone laparoscopic surgery. Each patient's medical records were reviewed, with intraoperative and postoperative parameters, including complications, being recorded. RESULTS: Transperitoneal laparoscopic nephrectomy was successful in five patients (83%). Hand-assist ports were utilized in two patients because of failure to progress. The operative times were 301 +/- 106 minutes and 167 +/- 40 minutes in the laparoscopic and open-surgery groups, respectively (P = 0.03). There was no statistical difference with regard to estimated blood loss, transfusion rate, or parenteral analgesic requirements, but there was a trend toward a shorter stay for the laparoscopic group. Complications were noted in three and two patients in the laparoscopic and open-surgery groups, respectively. CONCLUSIONS: The outcomes of nephrectomy for XGP were similar regardless of surgical approach. The results in patients with XGP were similar to initial reports in the literature and may be dependent on surgeon experience. We believe that in experienced hands, laparoscopic nephrectomy may be offered to patients with XGP.

Prostatic stents for the treatment of benign prostatic hyperplasia.

PURPOSE OF REVIEW: The insertion of prostatic stents in the treatment of lower urinary tract symptoms in men secondary to benign prostatic obstruction from benign prostatic hyperplasia has proven to be an effective modality in properly selected patients. We review the current literature on the role of prostatic stents in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. RECENT FINDINGS: Permanent stents such as the Urolume and the Memokath offer efficacious and safe treatment alternatives for men with bladder outlet obstruction from benign prostatic hyperplasia who are deemed high surgical risks for traditional transurethral resection of the prostate. When removal of permanent prostatic stent is necessary, the design of the Memokath allows for an easier removal than that of the Urolume. Temporary stents are being investigated as a means to treat the transient bladder outlet obstruction frequently observed after minimally invasive thermotherapy procedures aimed at treating benign prostatic obstruction, with both biodegradable and retrievable stents shown as successful modalities for this indication. SUMMARY: Prostatic stents remain an option to treat men with benign prostatic obstruction/bladder outlet obstruction; however, stent migration remains an obstacle to their widespread use. The key to obtaining optimal outcomes in men with benign prostatic hyperplasia is careful patient selection and experience with proper stent deployment.