British JournalofUrology (1992), 69, 381-382
01992 British Journal of Urology
A Simple Method for Insertion of an lntraprostatic Coil 0. G. NIEBEN, J. NORDLING, K. K. NIELSEN, B. KROMANN-ANDERSEN, MARY J. ABSALOM and C. FOWLER Departments of Urology, Herlev Hospital, University of Copenhagen, Denmark. and The Royal London Hospital, London
Summary-A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients. The prostatic urethra is measured either by abdominal/transrectaI ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 2 1 coils were correctly positioned at the first attempt using this new method-a success rate equivalent to that of ultrasound-guided insertion.
The urethral coil was introduced by Fabian in 1980 for the treatment of bladder outflow obstruction due to benign prostatic hypertrophy. Several reports have confirmed the value ofthe technique (Nordling et al., 1989; Billiet et al., 1990; Harrison and De Souza, 1990; Yachia et al., 1990) as an alternative to surgery in patients who refuse prostatic surgery or are too unwell to undergo it. The coil is inserted under topical urethral anaesthesia, in principle as an out-patient procedure. Until now, insertion of the stent has been guided by transabdominal ultrasound scanning (Nordling etal., 1989; Billiet etal., 1990) or by direct inspection using a rigid endoscope (Fabian, 1980; Harrison and De Souza, 1990). We have tested a new method of insertion of the urethral coil (Prostakath@)which can be used when ultrasound is not available.
ured. A Prostakath is selected which is 10 to 15 mm longer than the measured prostatic length. 2 . A Foley catheter inserted into the urethra is gently drawn back until the balloon is resting against the bladder neck. 3. A mark is made on the catheter 15 cm from a fixed reference point at the sulcus between the pubic bone and the root of the penis (Fig. 1). 4. The balloon isdeflated and the catheter removed so that the distance K between the balloon and the mark can be measured (Fig. 2). a
Materials and Methods The Prostakath is made in 7 lengths from 35 to 95 mm and comes with a specially designed insertion catheter. The steps in the new method of insertion are as follows. 1. The length of the prostatic urethra from the bladder neck to the external sphincter is measAccepted for publication 25 April 1991
Fig. 1 A mark is made at the root of the penis and at a distance P = 15 cm on the catheter after the balloon has been gently positioned so as to rest on the bladder neck.
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BRITISH JOURNAL OF UROLOGY I
Fig. 2 Distance K is measured from the balloon to the mark on the Foley bag catheter
Fig. 3 Distance L is calculated as length of corpus of the coil subtracted from the prostatic urethral length and added to the distance K. During insertion the marker on the insertion catheter, as shown by the broad arrow, is placed at distance P = 15 cm from the mark on the root of the penis.
5 . A mark is made on the Prostakath insertion
catheter at a distance L from the tip of the coil, where L is given by the simple formula L = K + (Prostakath length- prostatic length).
6. The Prostakath is then inserted using an F7 ureteric catheter as a guide as previously described (Nordling et al., 1989) until the mark on the insertion catheter is 15 cm from the reference point at the root of the penis. 7. The position of the stent is checked by urethroscopy or ultrasound immediately after insertion and adjustments made where necessary.
Results The Prostakath urethral coil was inserted using this method in 25 patients with bladder outflow obstruction due to benign prostatic disease. The median age was 77 years (range 62-94). The median prostatic urethral length was 4.8 cm (range 3.56.9). Insertion of the coil was performed under topical urethral anaesthesia in all patients without complications. Urethroscopy or ultrasound after insertion revealed 21 coils correctly placed, 2 coils 1 cm too distal and 2 coils 1 cm too proximal. The distally placed coils were easily pushed into position and the proximal coils were re-sited with endoscopic forceps. All patients voided freely immediately after the Prostakath was correctly positioned, with a maximum flow rate of 8 to 38 ml/s (median 30.2). No patient was incontinent after the procedure.
Discussion This method for insertion of the Prostakath is simple and was well received by the patients. It does not require ultrasound because the prostatic urethra can be measured during the flexible or rigid cystourethroscopy which we customarily perform to exclude bladder stones or tumours before the coil is inserted. We believe that the new method will allow more widespread application of this useful device.
References Billiet, I., Mattelaer, J. and Van Brien, P. (1990). Use of transrectal longitudinal sonography in the placement of a prostatic coil. Eur. Urol., 1 7 , 7 6 7 8 . Fabian, K. M. (1980). Der intraprostatische "Partielle Katheter" (Urologische Spirale). Urologe A , 19,236238. Harrison, N. W. and De Souza, J. V. (1990). Prostatic stenting for outflow obstruction. Br. J. Urol., 65, 192-196. Nordling, J., Holm, H. H., Klarskov, P. e r d (1989). The intraprostatic spiral : A new device for insertion with the patient under local anesthesia and with ultrasonic guidance with 3 months of followup. J . Urol., 142,756758. Yachia, D., Lask, D. and Rabmson, S. (1990). Self-retaining intraurethral stent : an alternative to long-term indwelling catheters or surgery in the treatment of prostatism. Am. J. Radiol., 154, 1 11-1 13.
The Authors 0. G. Nieben, MD, Registrar, Herlev Hospital. J. Nordling, Dr Med Sci, Consultant Urologist, Herlev Hospital. K. K. Nielsen, MD, Research Fellow, Herlev Hospital. B. Kromann-Andersen, MD, Research Fellow, Herlev Hospital. Mary J. Absalom, RGN, Registrar, Royal London Hospital. C. Fowler, FRCS(Urol), Consultant, Royal London Hospital.
Requests for reprints to: 0. G. Nieben, Peblinge Dossering 18, DK-2200 Copenhagen, Denmark.
01992 British Journal of Urology
A Simple Method for Insertion of an lntraprostatic Coil 0. G. NIEBEN, J. NORDLING, K. K. NIELSEN, B. KROMANN-ANDERSEN, MARY J. ABSALOM and C. FOWLER Departments of Urology, Herlev Hospital, University of Copenhagen, Denmark. and The Royal London Hospital, London
Summary-A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients. The prostatic urethra is measured either by abdominal/transrectaI ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 2 1 coils were correctly positioned at the first attempt using this new method-a success rate equivalent to that of ultrasound-guided insertion.
The urethral coil was introduced by Fabian in 1980 for the treatment of bladder outflow obstruction due to benign prostatic hypertrophy. Several reports have confirmed the value ofthe technique (Nordling et al., 1989; Billiet et al., 1990; Harrison and De Souza, 1990; Yachia et al., 1990) as an alternative to surgery in patients who refuse prostatic surgery or are too unwell to undergo it. The coil is inserted under topical urethral anaesthesia, in principle as an out-patient procedure. Until now, insertion of the stent has been guided by transabdominal ultrasound scanning (Nordling etal., 1989; Billiet etal., 1990) or by direct inspection using a rigid endoscope (Fabian, 1980; Harrison and De Souza, 1990). We have tested a new method of insertion of the urethral coil (Prostakath@)which can be used when ultrasound is not available.
ured. A Prostakath is selected which is 10 to 15 mm longer than the measured prostatic length. 2 . A Foley catheter inserted into the urethra is gently drawn back until the balloon is resting against the bladder neck. 3. A mark is made on the catheter 15 cm from a fixed reference point at the sulcus between the pubic bone and the root of the penis (Fig. 1). 4. The balloon isdeflated and the catheter removed so that the distance K between the balloon and the mark can be measured (Fig. 2). a
Materials and Methods The Prostakath is made in 7 lengths from 35 to 95 mm and comes with a specially designed insertion catheter. The steps in the new method of insertion are as follows. 1. The length of the prostatic urethra from the bladder neck to the external sphincter is measAccepted for publication 25 April 1991
Fig. 1 A mark is made at the root of the penis and at a distance P = 15 cm on the catheter after the balloon has been gently positioned so as to rest on the bladder neck.
38 1
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BRITISH JOURNAL OF UROLOGY I
Fig. 2 Distance K is measured from the balloon to the mark on the Foley bag catheter
Fig. 3 Distance L is calculated as length of corpus of the coil subtracted from the prostatic urethral length and added to the distance K. During insertion the marker on the insertion catheter, as shown by the broad arrow, is placed at distance P = 15 cm from the mark on the root of the penis.
5 . A mark is made on the Prostakath insertion
catheter at a distance L from the tip of the coil, where L is given by the simple formula L = K + (Prostakath length- prostatic length).
6. The Prostakath is then inserted using an F7 ureteric catheter as a guide as previously described (Nordling et al., 1989) until the mark on the insertion catheter is 15 cm from the reference point at the root of the penis. 7. The position of the stent is checked by urethroscopy or ultrasound immediately after insertion and adjustments made where necessary.
Results The Prostakath urethral coil was inserted using this method in 25 patients with bladder outflow obstruction due to benign prostatic disease. The median age was 77 years (range 62-94). The median prostatic urethral length was 4.8 cm (range 3.56.9). Insertion of the coil was performed under topical urethral anaesthesia in all patients without complications. Urethroscopy or ultrasound after insertion revealed 21 coils correctly placed, 2 coils 1 cm too distal and 2 coils 1 cm too proximal. The distally placed coils were easily pushed into position and the proximal coils were re-sited with endoscopic forceps. All patients voided freely immediately after the Prostakath was correctly positioned, with a maximum flow rate of 8 to 38 ml/s (median 30.2). No patient was incontinent after the procedure.
Discussion This method for insertion of the Prostakath is simple and was well received by the patients. It does not require ultrasound because the prostatic urethra can be measured during the flexible or rigid cystourethroscopy which we customarily perform to exclude bladder stones or tumours before the coil is inserted. We believe that the new method will allow more widespread application of this useful device.
References Billiet, I., Mattelaer, J. and Van Brien, P. (1990). Use of transrectal longitudinal sonography in the placement of a prostatic coil. Eur. Urol., 1 7 , 7 6 7 8 . Fabian, K. M. (1980). Der intraprostatische "Partielle Katheter" (Urologische Spirale). Urologe A , 19,236238. Harrison, N. W. and De Souza, J. V. (1990). Prostatic stenting for outflow obstruction. Br. J. Urol., 65, 192-196. Nordling, J., Holm, H. H., Klarskov, P. e r d (1989). The intraprostatic spiral : A new device for insertion with the patient under local anesthesia and with ultrasonic guidance with 3 months of followup. J . Urol., 142,756758. Yachia, D., Lask, D. and Rabmson, S. (1990). Self-retaining intraurethral stent : an alternative to long-term indwelling catheters or surgery in the treatment of prostatism. Am. J. Radiol., 154, 1 11-1 13.
The Authors 0. G. Nieben, MD, Registrar, Herlev Hospital. J. Nordling, Dr Med Sci, Consultant Urologist, Herlev Hospital. K. K. Nielsen, MD, Research Fellow, Herlev Hospital. B. Kromann-Andersen, MD, Research Fellow, Herlev Hospital. Mary J. Absalom, RGN, Registrar, Royal London Hospital. C. Fowler, FRCS(Urol), Consultant, Royal London Hospital.
Requests for reprints to: 0. G. Nieben, Peblinge Dossering 18, DK-2200 Copenhagen, Denmark.
