Spiral urethral prosthesis as an alternative to surgery in high risk patients with benign prostatic hyperplasia: prospective study.

A spiral urethral prosthesis was inserted with use of local anesthesia in 22 patients with benign prostatic hyperplasia who had long-term indwelling bladder catheters (mean 13 months) and anesthetic contraindications to an operation (American Society of Anesthesiologists rating of 4 in 86% of the patients). Of the 22 patients 7 (31.8%) did not reach 12 months of followup for different reasons. The remaining 15 patients were followed with clinical evaluations, urine cultures, transrectal ultrasound, voiding urethrography and urine flow rates at 3, 6 and 12 months. Final evaluation at 12 months showed normal voiding in 74% of the patients with an absence of significant post-void residual in all. In 10 patients (67%) urinary flow rates varied between 6 and 14 cc per second and in the remaining it was less than 6 cc per second. In 60% of the patients urine culture was negative. Our results suggest that a spiral urethral prosthesis, placed with the patient under local anesthesia, is an excellent substitute for long-term, indwelling, bladder catheterization, and is a useful alternative to an operation in patients with an increased surgical risk.