Interventional procedure overview of prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia

Indications and current treatment

LUTS caused by BPH commonly affect men aged over 50. BPH results from an increase in number of stromal and epithelial cells. These cells are typically in the periurethral region of the prostate, with large discrete nodules compressing the urethra. Symptoms include hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention.

NICE's guideline on lower urinary tract symptoms in men describes current treatment options. Mild symptoms are usually managed conservatively. Medicines such as alpha blockers and 5-alpha-reductase inhibitors may also be used. If other treatments have not worked, there are several possible surgical options, including TURP, transurethral vaporisation, holmium laser enucleation, prostatic urethral lift implant insertion, prostatic artery embolisation and prostatectomy. Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction.

What the procedure involves

The aim of prostatic urethral temporary implant insertion is to relieve symptoms of BPH by creating new channels in the urethra to increase the flow of urine. The aim of using a temporary implant is to avoid complications from an implant left in place long term.

Local anaesthesia or light sedation is used. A folded device made from nitinol is inserted into the prostatic urethra under direct visualisation using a cystoscope. The device is opened in the urethra. Over the following days, the pressure applied by struts in the device creates areas of ischaemia in the prostatic urethra and bladder neck. This makes new longitudinal channels through which urine can flow. After 5 to 7 days, lidocaine gel and a flexible silicone extraction catheter are inserted into the urethra and the device is removed. Insertion and removal of the device are both done as day-case procedures.

Outcome measures

IPSS

The IPSS is a validated questionnaire used to assess symptoms of BPH. It is also referred to as the American Urological Association BPH Symptom Score Index. It includes questions on 7 dimensions during the previous month (feeling of incomplete bladder emptying, frequency, intermittency, urgency, weak stream, straining and nocturia) and scored from 1 to 5. Higher scores represent worse symptoms. An IPSS score of 0 to 7 indicates mild symptoms, 8 to 19 indicates moderate symptoms and 20 to 35 indicates severe symptoms. An additional question asks men how they feel about their BPH symptoms. The response yields a score for quality of life (ranging from 0 to 6, with 0 representing 'delighted' and 6 representing 'terrible').

IIEF

The IIEF questionnaire includes 15 questions divided into 5 domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. The total score ranges from 1 to 75, from worst to best.

SHIM

The SHIM questionnaire (also known as the IIEF-5) is a modified version of the 15-item IIEF. It has 5 questions and the total score ranges from 5 to 25, with lower scores indicating more severe erectile dysfunction.