Objective To assess the use of a thermo-expandable intraprostatic stent (Memokath 1 , 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 55uC. 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 NHS strives to create and promote a safe environment for patient care in which risks are minimised. Urinary catheterisation is a common healthcare procedure but it is an invasive intervention that carries the risk of infection. Evidence-based guidelines have been developed to minimise the risks associated with these devices and to allow healthcare professionals to implement best practice at all times. This article looks at evidence-based guidance and technological innovations aimed at reducing infection risks and improving patient outcomes.
RESULTSNinety-three patients had their stents removed at the three reporting centres; the mean indwelling time of their stent was 12.9 months, and most stents were inserted for symptomatic benign prostate disease. Reasons for removal included recurrent outlet or storage-type urinary symptoms, migration of the stent, stent-related pain, recurrent urosepsis and detrusor failure. The stents were removed on a day-case basis in 32% of patients. Topical anaesthesia or no anaesthesia was used in 48%. Of these patients, only 9% described moderate discomfort or worse. The procedure took a mean of 11 min and was felt to be easy or fairly easy in 90% of patients.
CONCLUSIONSThese data show the ease of removal of the Memokath 028 stent, reinforce its overall success in achieving the requirements of the ideal intraprostatic stent, and further emphasize the advantages of this implant over the epithelializing, permanent intraprostatic stent.
The NHS strives to create and promote a safe environment for patient care in which risks are minimised. Urinary catheterisation is a common healthcare procedure but it is an invasive intervention that carries the risk of infection. Evidence-based guidelines have been developed to minimise the risks associated with these devices and to allow healthcare professionals to implement best practice at all times. This article looks at evidence-based guidance and technological innovations aimed at reducing infection risks and improving patient outcomes.
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