Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction

Abstract

The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following high-energy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes.

Male urethral strictures and their management

“…Temporary stents such as the Spanner® stent (SRS Medical, USA) require exchange every 3–12 months depending on the type of stent, and are more suitable for men with posterior urethral obstruction. 56 Permanent stents, such as the Urolume® (Endo Health Solutions, USA) and Memotherm® (Bard, Germany) stent, are placed into the bulbar urethra and incorporated into the wall of the urethra. 57–59 However, use of these stents has been largely abandoned and, in some countries, these stents have been removed from the market because of limited use and high rates of complications such as perineal pain, stent migration, stent obstruction (owing to tissue hyperplasia or stone encrustation), incontinence, and infection.…”