Thermo-expandable intraprostatic stents in bladder outlet obstruction: an 8-year study.

OBJECTIVE: To assess the use of a thermo-expandable intraprostatic stent (Memokath(R), Engineers and Doctors A/S, Copenhagen, Denmark) for bladder outlet obstruction in men unable to undergo transurethral resection of the prostate (TURP), assessing symptoms, complications and duration of stent life. PATIENTS AND METHODS: The Memokath stent is a coil of a nickel-titanium alloy which has 'shape memory', the lower end expanding when heated to 55 degrees C. Risks associated with inserting the stent with a flexible cystoscope under local anaesthesia are minimal. Men were selected who were either permanently or temporarily unfit for TURP. Indications included severe respiratory and cardiovascular disease. Exclusion criteria included bladder carcinoma, calculi or detrusor failure; in all, 211 men were fitted with 217 intraprostatic stents over 8 years. RESULTS: There were 1511 TURPs during the study period; the mean age of men receiving a stent was 80.2 years, compared with 70.2 years for those undergoing TURP. The International Prostate Symptom Score decreased from a mean of 20.3 to 8.2 (P < 0.001) in the first 3 months after stent placement; there was virtually no change over 7 years. During the follow-up, 38% of men died with their stents in situ, 34% remain alive, 23% have had their stents removed for failure and 4% were removed as they were no longer required. There was a 13% migration rate and 16% repositioning rate. There were few side-effects (pain 3%, haematuria 3%, incontinence 6% and infection 6%). These frail men were more likely to die than have their stent fail. CONCLUSION: The Memokath intraprostatic stent is a valuable addition to the armamentarium of the urologist treating elderly or frail men with advanced bladder outlet obstruction and complements existing technologies.

The nurse cystoscopist: a feasible option?

OBJECTIVES: To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy. PATIENTS AND METHODS: Eighty-three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other's findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy. RESULTS: Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance-corrected proportional agreement (Kappa) was 0.94, indicating very close agreement. CONCLUSION: A UNP can be trained to perform cystoscopy and detect suspicious lesions as accurately as can a consultant urologist. Legal and training issues in implementation are important.