Treating bladder-outflow obstruction with thermo-expandable prostate metal stents.

Bladder-outflow obstruction is a common age-related clinical entity due to a variety of benign and malignant diseases of the prostate. Surgical treatment is not suitable for high-risk elderly patients who seek minimally invasive management. We present a prostatic thermo-expandable metal stent for treating bladder-outflow obstruction. In this review, we include the design characteristics of this novel device, the performance assessment in comparison with alternative devices, the limitations, our personal clinical experience, as well as a long-term perspective. According to our experience among 127 patients (who underwent insertion of 192 stents) after 1, 2 and 3 years, 82, 61 and 47% of the original stents were functional without apparent complications, respectively. The mean single stent indwelling time was 1 year, with a maximum of 4 years. In 41% of patients, the stent needed to be removed and/or exchanged owing to stent encrustation (15%), migration (10%), penile pain (6%), bladder-outflow obstruction symptoms (5%), urinary incontinence (<3%), tissue granulation (<3%), recurrent urinary tract infections (<3%) or urethral stricture (<3%). The thermo-expandable prostatic stent seems to be an effective minimally invasive treatment of bladder-outflow obstruction, especially in high-risk patients.

Pain in extracorporeal shock wave lithotripsy.

Pain tolerance has long been identified as a factor influencing successful treatment of renal calculi by shock wave lithotripsy (SWL). We aimed to clarify which factors directly influence pain tolerance to predict which patients are likely to undergo successful treatment. We analysed retrospectively 179 patients who received their first SWL for a solitary kidney stone. All patients were on a non-opioid analgesia protocol and were treated on an outpatient basis. The target was to deliver 4,000 shock waves at an energy level of 4. In total, 53% of patients could tolerate the targeted shock wave number and energy and were retrospectively allocated into group A. Those who required a reduction in either energy levels or shock wave number were allocated in group B. Multivariate and univariate analysis showed that female patients, who are young with thin body habitus, have lower pain tolerance to SWL.