Description
This webinar explores the evolving role of prostatic stents in the management of benign prostatic hyperplasia (BPH), focusing on appropriate patient selection and clinical indications. The session will cover procedural techniques, device options, and practical considerations for stent placement and removal. Experts will discuss short- and long-term outcomes, complication profiles, and comparison with medical and surgical alternatives. Real-world case experiences will highlight decision-making in complex or high-risk patients. Designed for urologists and healthcare professionals, this webinar aims to provide evidence-based guidance for integrating BPH stents into clinical practice.
Summary Listen
- **The Growing Burden of Lower Urinary Tract Symptoms (LUTS)**
- Male LUTS are a global concern, affecting a significant portion of the male population. The prevalence is estimated to be over a billion men worldwide, and the most common cause of LUTS is Benign Prostatic Hyperplasia (BPH). Guidelines exist for BPH management, but they have limitations, including a lack of consideration for patient values and preferences. Many men are dissatisfied with current medical therapies and seek alternatives.
- **Current Medical and Surgical BPH Treatment Landscape**
- Many men with BPH are on medical therapy, but only half are satisfied with the effectiveness. Side effects are a significant concern. Current surgical options, while effective, carry risks such as anesthesia complications, erectile dysfunction, and urinary incontinence. A large portion of men with LUTS are not actively managed or receiving adequate relief, highlighting an underserved surgical market.
- **Patient Preferences and Desired Treatment Outcomes**
- Patients desire BPH treatments with high benefit and low risk, preferring less invasive options with minimal adverse events. Preservation of sexual function is a top priority, with most men preferring treatments that avoid sexual side effects. Improving urgency and incontinence is also highly valued. Patients seek safe, well-tolerated, and efficacious treatments that offer rapid relief, improved quality of life, and preserved function.
- **Limitations of Current Treatment Approaches**
- The current surgical treatment approach for BPH is often volume-based. Options include water vapor therapy, prostatic urethral lift, resection, enucleation, and aquablation. Patient preference is a crucial factor in selecting the appropriate treatment. Existing minimally invasive therapies include UroLift, Rezum, and TUMT, with emerging interest in stent-based solutions.
- **The Rise of BPHCETS (BPH Conformal Endourethral Treatment Solutions)**
- A new class of treatments called BPH Conformal Endourethral Treatment Solutions is emerging. These treatments aim to provide BPH relief with no specialized equipment or electrical supply using a cystoscope. Early stent designs failed due to storage symptoms and incrustation, which required a need for a new design. Stents should open the prostatic fossa, minimize foreign body, tailor to a variety of prosthetic shapes and be easy to insert and remove.
- **Novel Stent Technologies and Clinical Data**
- Several novel stent technologies are under development. The Zenthalostat has shown promising 24-month data with improvements in IPSS and quality of life. The Rivermark Flowstand, designed for use with standard cystoscopes, has demonstrated efficacy in treating urinary retention. The EuroCrossStent offers temporary relief with a six-month dwell time.
- **Emerging Stent Technologies and Early Results**
- The provarium-proV-expander is a permanent nitinol implant with a 3D geometry that mirrors the anatomy of the prostate. The butterfly device is designed to fit within the lateral lobes of the prostate, and the Pro Arc Ring Clear has shown early success in clinical trials. The Alium Stent has been available since 2016 and has demonstrated improvement in IPSS and flow rate in a study of 51 patients.
- **Future Considerations and Challenges for BPHCETS**
- Stent technologies are evolving with improvements in material, design, and delivery systems. Challenges remain in determining the optimal stent composition, shape, and rigidity. The long-term durability, migration, and encrustation are also concerns. Further research is needed to determine the ideal metrics for evaluating the efficacy of stents compared to other BPH treatments.
- **Patient-Centric Approach and Decision-Making**
- As minimally invasive therapies become more prevalent, it's crucial to engage patients in the decision-making process. Understanding their values and preferences, particularly regarding ejaculatory preservation, is essential. Proper patient selection based on anatomy, size, shape, and other factors will play a key role in optimizing treatment outcomes.
Sample Certificate
About the Speakers
Dr. Bilal Chugtai
Chief of Urology, Plainview Hospital, Associate Professor of Urology, Donald and Barbara Zucker School of Medicine, New York, United States
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