Urology Times - July 2009 - (Page 17) www.urologytimes.com JULY 2009 17 Curr Urol Rep 2003; 4:282-6; J Urol 1996; 155:1956-8; J Endourol 1997; 11:473-5). found the temporary stent to perform well in this UT Table 2 Clinical applications for Spanner use* population; however, while Patient populations/applications CE-mark approval permits Number of Percentage In our urologic practices, this stent has its use in patients for up Clinical application patients of total provided a new management option for a to 90 days, FDA labeling Minimally invasive BPH treatment 72 35% diverse patient population of 206 men suf- restricts stent placement to (ie, TUMT, TUNA) fering from BOO (table 2). Many patients 30 days. Many patients in Minimally invasive treatment of can realize the benefits of the stent because this population need stentlocalized prostate cancer (ie, cryo56 27% its design allows for office-based inser- ing for a period longer than therapy, brachytherapy, EBRT) tion and removal without general anes- 30 days. Two patients in our Chronic catheter/Differential series are currently wearing 40 19% diagnosis their sixth stent with good Acute urinary retention/Failed results. We anticipate ongo21 10% There have been few reports of voiding trial ing periodic replacement of Prostatic stenosis/ Bladder neck their stents. Further followstent migrations, expulsions, 12 10% contracture up is required to determine or clinically signi cant stent whether there are any evenPostoperative retention, 5 2% tual consequences of longnon-urologic surgery encrustation after implantation. term stent use. Total 206 After minimally invasive thesia, cystoscopy, or radiologic imaging. surgery for BPH. Clinically, *Numbers derived from stent application by authors in their respective clinical practice Although cystoscopy is not required to place this stent is well suited for Source: Neal D. Shore, MD; Mirza M. Baig, MD; Anthony L. Cantwell, MD; Douglas O. Chinn, MD; Luay P. Susan, MD the device, it can be useful for assessing patients where post-treatunderlying anatomy and pathophysiology ment edema further worsprior to placement. The treating urologist ens voiding efficiency after can determine whether cystoscopy prior to minimally invasive treatment for BPH. As cancer. Patients treated with cryotherapy, placement is warranted. demonstrated in the clinical trial leading brachytherapy, high-intensity focused ultraUnfit for BPH surgery. The most intuitive to FDA approval, the device significantly sound (HIFU), or external beam radiation clinical application for temporary or per- improved post-void residual urine and uro- therapy for localized prostate cancer also manent prostatic stenting is in men who flowmetry during the most acute period of may suffer from procedure-induced edema are deemed unfit for surgery because of prostatic healing following transurethral and BOO (J Urol 2003; 170:12-9; Issues in significant comorbidities or prior prostate microwave therapy (TUMT) (J Urol 2007; Urology 2007; Jan/Feb:24-30). In our clinitreatment (eg, brachytherapy). We have 177:1040-6). cal observations, these patients realize the Similarly, the International Pros- stent’s benefit of improved quality of life tate Symptom Score most signifi- similar to that of post-TUMT patients. cantly improved with Spanner use Protracted catheter wear. Patients in our UT Table 1 in the first weeks following TUMT, practices who have been managed with when the standard of care group chronic indwelling or intermittent catheterIdeal performance criteria for experienced worsening of bladder ization have done very well with this stent. a temporary prostatic stent emptying problems (J Urol 2007; A scheduled replacement protocol, similar 177:1040-6; Urology 2008; 71:873- to that used in men in the unfit-for-surgery Provides a patent lumen through the prostate, 7). Surprisingly, while the stent was category, has been effective in these patients allowing volitional voiding in place, irritative symptoms and as well. Ease of insertion and removal (ie, office-based, bother scores (based on the Benign Several men who were extremely diswith no anesthetic or radiologic requirements) Prostatic Hyperplasia Impact Index) satisfied with wearing a Foley catheter Bi-directional stability within the prostate (ie, no were similar or improved in the Span- have been offered this stent. Although we migration or expulsion) ner group compared to the standard felt their detrusor muscle was impaired, Patient comfort and satisfaction of care group. Thus, stenting did not the minimal risk involved with trying the Improved lower urinary tract symptoms generate additional irritation beyond stent allowed us to provide these patients that of TUMT alone (Urology 2008; with this option. To our surprise, many of Resistant to encrustation 71:873-7). the men were able to void efficiently with Maintains continence In our clinical experience, stent the stent in place. These patients, more than Minimal tissue irritation use markedly improves quality of any other, expressed their appreciation for Minimizes urinary tract infection compared to interlife in patients who undergo mini- a new-found ability to void volitionally and mittent or indwelling catheters mally invasive BPH treatments by improved quality of life. decreasing the need for indwelling LUTS of unknown etiology. Every practice Cost effective catheterization and leg bag usage. encounters patients suffering from LUTS This is more evident in men who are with unknown or non-definitive etiology. Source: Adapted from Cockett AT, Aso Y, Denis L, et al. Recommendations of the International Consensus Committee concerning: 4. in AUR prior to treatment due to the This group offers perhaps the most intriguTreatment recommendations for Benign Prostatic Hyperplasia (BPH). longer post-treatment catheterization ing clinical application for the stent. By Proceedings of the Third International Consultation on Benign Prostatic Hyperplasia. Monaco, 26-28 June 1996; pgs. 625-50. period. stenting the prostate, we are able to reduce After minimally invasive therapy for urethral resistance while determining http://www.urologytimes.com Table of Contents for the Digital Edition of Urology Times - July 2009 Urology Times - July 2009 Contents Perspective 360˚ Guide/Letters News Hands On Speak Out Coding Q&A New Products & Services In the Public Eye What's Your Experience? Meeting Calendar Washington and You Urology Times - July 2009 Urology Times - July 2009 - (Page Intro) Urology Times - July 2009 - Contents (Page Cover1) Urology Times - July 2009 - Contents (Page Cover2) Urology Times - July 2009 - Contents (Page 3) Urology Times - July 2009 - Perspective (Page 4) Urology Times - July 2009 - Perspective (Page 5) Urology Times - July 2009 - 360˚ Guide/Letters (Page 6) Urology Times - July 2009 - 360˚ Guide/Letters (Page 7) Urology Times - July 2009 - News (Page 8) Urology Times - July 2009 - News (Page 9) Urology Times - July 2009 - News (Page 10) Urology Times - July 2009 - News (Page 10a) Urology Times - July 2009 - News (Page 10b) Urology Times - July 2009 - News (Page 10c) Urology Times - July 2009 - News (Page 10d) Urology Times - July 2009 - News (Page 11) Urology Times - July 2009 - News (Page 12) Urology Times - July 2009 - News (Page 13) Urology Times - July 2009 - News (Page 14) Urology Times - July 2009 - News (Page 15) Urology Times - July 2009 - Hands On (Page 16) Urology Times - July 2009 - Hands On (Page 17) Urology Times - July 2009 - Hands On (Page 18) Urology Times - July 2009 - Hands On (Page 18a) Urology Times - July 2009 - Hands On (Page 18b) Urology Times - July 2009 - Hands On (Page 18c) Urology Times - July 2009 - Hands On (Page 18d) Urology Times - July 2009 - Hands On (Page 19) Urology Times - July 2009 - Hands On (Page 20) Urology Times - July 2009 - Hands On (Page 21) Urology Times - July 2009 - Hands On (Page 22) Urology Times - July 2009 - Hands On (Page 23) Urology Times - July 2009 - Speak Out (Page 24) Urology Times - July 2009 - Coding Q&A (Page 25) Urology Times - July 2009 - Coding Q&A (Page 26) Urology Times - July 2009 - Coding Q&A (Page 27) Urology Times - July 2009 - Coding Q&A (Page 28) Urology Times - July 2009 - Coding Q&A (Page 29) Urology Times - July 2009 - Coding Q&A (Page 30) Urology Times - July 2009 - New Products & Services (Page 31) Urology Times - July 2009 - In the Public Eye (Page 32) Urology Times - July 2009 - In the Public Eye (Page 33) Urology Times - July 2009 - What's Your Experience? (Page 34) Urology Times - July 2009 - What's Your Experience? (Page 35) Urology Times - July 2009 - What's Your Experience? (Page 36) Urology Times - July 2009 - What's Your Experience? (Page 37) Urology Times - July 2009 - What's Your Experience? (Page 38) Urology Times - July 2009 - What's Your Experience? (Page 39) Urology Times - July 2009 - Meeting Calendar (Page 40) Urology Times - July 2009 - Washington and You (Page 41) Urology Times - July 2009 - Washington and You (Page 42) Urology Times - July 2009 - Washington and You (Page Cover3) Urology Times - July 2009 - Washington and You (Page Cover4) Urology Times - July 2009 - Washington and You (Page MM) http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201009 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201007 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201006 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_20100515 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201005 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201004 http://digital.heatlhcaregroup.advanstar.com/nxtbooks/advanstar/ut_201003 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201002 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201001 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200912 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200911 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200910 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200909 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200908 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200907 http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_200906 http://www.nxtbook.com/nxtbooks/advanstar/ut_200905 http://www.nxtbook.com/nxtbooks/advanstar/ut_20090415 http://www.nxtbook.com/nxtbooks/advanstar/ut_200904 http://www.nxtbook.com/nxtbooks/advanstar/ut_200903 http://www.nxtbook.com/nxtbooks/advanstar/ut_200902 http://www.nxtbook.com/nxtbooks/advanstar/ut_200901 http://www.nxtbook.com/nxtbooks/advanstar/ut_200812 http://www.nxtbook.com/nxtbooks/advanstar/ut_200811 http://www.nxtbookMEDIA.com
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