Insertion/Removal of Prostatic Stent

การใส่หรือถอดตัวถ่างขยายท่อปัสสาวะบริเวณต่อมลูกหมาก เป็นการผ่าตัดเล็กซึ่งต้องมีการตรวจกระเพาะปัสสาวะและท่อปัสสาวะด้วยกล้อง ศัลยแพทย์จะสอดท่อซึ่งทำจากวัสดุสังเคราะห์เข้าไปในต่อมลูกหมากเพื่อใช้สำหรับปัสสาวะ

Indications of stenting
  • Patients with lower urinary tract symptoms due to bladder outlet obstruction
  • Patients with benign prostatic obstruction
  • Patients with prostatic urethral obstruction
  • Procedure is done in a short time.
  • Bleeding during and after surgery is minimal.
  • A short hospital stay, the patient can be discharged the same day.
  • The stent may shift.
  • The stent may cause mild discomfort.
  • Pain while urinating for some time after the procedure.
  • If the stent is not sized correctly or placed correctly, the patient may experience urinary retention or slight incontinence until the problem is corrected.
  • Temporary relief of urinary retention may occur (short term).
  • Risk of stone formation on the stent.
Before the procedure, you will be asked to come in for a pre-assessment to assess your general fitness, screen for a urinary tract infection and to perform some baseline investigations. Usually patients are admitted on the same day as their surgery. If you are taking any prescribed medicines, discuss it with your doctor. You may need to stop taking it before the procedure.
The stent is put inside the prostate on the end of an instrument called a flexible cystoscope. This is a flexible instrument that can look inside the body. You stay awake during the procedure and local anesthetic jelly is placed in the urethra to make the procedure more comfortable. The flexible cystoscope is passed through the urethra into the prostate allowing the stent to be positioned appropriately. The whole procedure takes about 20 to 40 minutes and can be watched on a monitor.

If a stent is to be removed, this is performed by grasping it with a pair of forceps and extracting it through the penis. However, removing stents which have become embedded may require more complex surgery.
  • Drink twice as much fluid as you would normally for the next 24-48 hours to flush your system and minimize bleeding.
  • If you develop a fever, severe pain when passing urine, the inability to pass urine or worsening bleeding, you should contact the hospital immediately.
  • A prostatic stent is usually only a temporary solution to the problems caused by the prostate gland. You will therefore be reviewed on an outpatient basis after 6-8 weeks to consider whether a more permanent solution is appropriate.
The procedure may have the following potential side effects.
  • Common
    • Mild burning or bleeding when passing urine for a few days after the operation.
  • Occasional
    • Infection of the bladder requiring antibiotics.
    • Migration of the stent requiring replacement or removal.
  • Rare
    • The stent can worsen urinary symptoms (particularly leaking and frequency), requiring removal.
    • Injury to the urethra causing stricture formation.
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least three days or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
What if this procedure is not performed?
  • You would have urinary retention.
  • Your surgeon would do the suprapubic cystostomy (by means of immediate puncture) at the bedside.
  • Catheter indwelling is for long term or permanent. The main reason for leaving an indwelling catheter in place for the prolonged period is to relieve urinary retention.
Transurethral resection of the prostate (TURP), open surgery, laser prostate surgery, GreenLight laser PVP (photoselective vaporization of the prostate), drug treatment, long-term catheterization or observation.

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