Comparison between first-generation (fixed-caliber) and second-generation (self-expanding, large caliber) temporary prostatic stents

Abstract

In this study our aim was to compare a first-generation intraprostatic stent (Prostakath) with a second-generation one (ProstaCoil) in patients with prostatic obstruction. The comparison was made in terms of ease of insertion, need for repositioning, migration, infection, stone formation and length of time in place. One hundred and seventeen patients with an age range of 52-94 years were included in this study. Forty-nine of the patients were treated with gold-plated stainless-steel-made stent (Prostakath) inserted under sonographic and 68 of the patients were treated with a nitinol-made stent (ProstaCoil) inserted under fluoroscopic guidance. Indications for stent insertion were similar for both groups. We found that immediate correct positioning was 83% for the Prostakath and 100% for the ProstaCoil. In 42% of the cases the Prostakath necessitated later repositioning because of partial migration and in 12% of the cases removal because of complete migration into the bladder or the anterior urethra. No migration was observed with the ProstaCoil. In 10% of these cases the Prostakath could not be inserted because of the instability of the stent. Due to its larger caliber the second-generation stent caused more transient irritative symptoms. No difference was found in stent-induced infections (10% for all stents). Encrustations were found in 40% of the patients at 1 year with the Prostakath, but in 30% with the ProstaCoil at 2 years. Maximal indwelling time was 12 months with the Prostakath and 36 months with the ProstaCoil. We conclude that the second-generation stent was more advantageous because of its larger caliber allowing catheterization and endoscopic examinations, more flexibility and much longer indwelling time.