A Randomised Study to Evaluate the Efficacy of a Biodegradable Stent in the Prevention of Postoperative Urinary Retention after Interstitial Laser Coagulation of the Prostate

Abstract

Objective: Interstitial laser coagulation (ILC) of the prostate induces necrosis, oedema and increased risk for postoperative urinary retention. The present randomized study was carried out to investigate the feasibility and efficacy of a biodegradable self-reinforced polyglycolic acid (SR-PGA) stent in preventing postoperative urinary retention and the need for prolonged catheterization after ILC treatment. Material and methods: 35 males with benign prostatic enlargement (BPE) entered the study: 21 in the ILC + stent group and 14 in the ILC group without a stent. A suprapubic catheter was inserted for all patients and ILC was performed. The SR-PGA stent was inserted immediately after laser therapy in the stent group and kept open until the next morning when it was closed and the patient started trying to void. The suprapubic catheter was removed after voiding had started and the urinary bladder emptied adequately. Results: In the ILC + stent group voiding started on the first postoperative day in 17 patients and on the second day in 2 patients. Voiding was delayed in 2 cases: in 1 case due to inadequate length of the stent and in the other as a result of the stent placement being too proximal. There was 1 case of urinary retention due to early degradation of the stent. In the ILC-only group voiding started on average 6.1 days postoperatively. At 1 month follow-up, the mean peak urinary flow rate had increased significantly in the ILC + stent group (p < 0.05) but not in the ILC-only group (p = 0.26). Improvements in symptom scores were significant in both groups (p < 0.005) but in terms of the mean peak urinary flow rates at 6 months follow-up the improvement was significant only in the stent group (p < 0.05). Conclusions: The use of a SR-PGA stent enabled early voiding and is safe and effective in the treatment of postoperative urinary retention after ILC. The 3-4 week degradation time of the SR-PGA stent was too short for some patients. There is still a need for further development work to improve the stents and larger controlled studies to show the true value of biodegradable stents in the treatment of BPE.