Pétas A, Isotalo T, Talja M, Tammela T L, Välimaa T, Törmälä P
Department of Urology, Helsinki University Central Hospital, Finland.
Scand J Urol Nephrol. 2000 Aug;34(4):262-6. doi: 10.1080/003655900750042004.
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.
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.
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).
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.
前列腺间质激光凝固术（ILC）会导致坏死、水肿并增加术后尿潴留风险。本随机研究旨在探讨可生物降解的自增强聚乙醇酸（SR-PGA）支架预防ILC治疗后术后尿潴留及长期导尿需求的可行性和疗效。
35例良性前列腺增生（BPE）男性患者进入研究：21例在ILC+支架组，14例在无支架的ILC组。所有患者均插入耻骨上导管并进行ILC。支架组在激光治疗后立即插入SR-PGA支架，保持开放直至次日早晨关闭，患者开始尝试排尿。开始排尿且膀胱充分排空后拔除耻骨上导管。
ILC+支架组中，17例患者术后第1天开始排尿，2例在第2天开始排尿。2例排尿延迟：1例是由于支架长度不足，另1例是由于支架放置位置过于靠近近端。有1例因支架早期降解导致尿潴留。仅行ILC组平均术后6.1天开始排尿。在1个月随访时，ILC+支架组平均最大尿流率显著增加（p<0.05），而仅行ILC组未增加（p = 0.26）。两组症状评分均有显著改善（p<0.005），但在6个月随访时，仅支架组平均最大尿流率的改善具有显著性（p<0.05）。
使用SR-PGA支架可实现早期排尿，在治疗ILC术后尿潴留方面安全有效。SR-PGA支架3至4周的降解时间对部分患者来说过短。仍需要进一步开展研发工作以改进支架，并进行更大规模的对照研究来显示可生物降解支架在治疗BPE中的真正价值。
