Report On SIU 2007 : International Symposium On Urological Stents

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer;  Medical Devices;  Conferences
Article Date: 16 Sep 2007 - 0:00 PDT

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UroToday.com - At the centennial meeting of the Societe Internationale D'Urologie in Paris, the 7th International Symposium on Urologic Stents was held. The session was chaired by Daniel Yachia from Israel and was composed of 3 distinct sessions.

Session 1 was an update on stents and was begun by Jean de la Rosette's discussion on his work with urinary drainage after prostate thermotherapy. Jean quoted a world literature rate of urinary retention after this modality of 15-24% and discussed his research with the use of a variety of prostatic urethral stents post-procedure. His recommendation is that the stents have a role for 1-2 weeks post-procedure and potentially for those awaiting an intervention. Gopal Badlani from the US then discussed his extensive experience with the Urolume stent for the conditions of urethral stricture, benign prostatic hyperplasia and detrussor sphincter dysynergia. His discussed tricks o assure desired site of deployment, common reasons for failure, and tips for easier removal of the device. He also discussed some off-label indications, such as in anastomotic strictures after radical prostatectomy, which may be the fast growing indication for the Urolume stent. Vesna Stojanovic from Serbia then discussed a new polymer coated nitinol stent for use in recurrent bulbar urethral strictures. The Allium bulbar stent was placed in 30 patients via a fluoroscopic retrograde approach and was maintained in the urethra for an average on 12 months before removal which was much easier than with the removal of Urolume stents. After a period of an additional 10 months of follow-up, only 3 patients were found to have recurrences of their strictures. Finally, Ravi Kilkarni from Surrey, UK discussed his experience with the use of metallic ureteral stents. He presented his data of the use of the Memokath stent in 72 ureters in 53 patients with an average follow-up of 11 years. Thirteen reinsertions were required but the patients did exceedingly well with a total absence of lower urinary tract symptoms due to the absence of the stent in the bladder. The stents are contraindicated in strictures or obstructions involving the ureteral orifice.

Session 2 dealt with stents and drug delivery and was chaired by Daniel Lachia and Evangelos Liatsikos from Greece. Naama Kohn from Allium Medical Limited in Israel began with a discussion on biostable and biodegradable polymers for drug delivery. This basic science talk discussed the chemistry of polymers and drug delivery via soluble layers on stents. Amorphous polymers allow the delivery of a variety of drugs that diffuse over a set period of time. Most of the experience in this arena has been with coronary stents that have been treated with paclitaxel that inhibits the proliferation of both smooth muscle and endothelial cells. Evangelos Liatsikos then discussed his clinical experience with drug eluting stents used for ureteral obstruction. Specifically, he discussed the use of a metallic stent that was treated with paclitaxel, a tacrolimus derivative that provides irreversible inhibition of urothelial cells and smooth muscle cells. These stent would a permanent treated for both malignant and benign cases of ureteral obstruction and obviate the need for periodic changing. Daniel Yachia then discussed potential for targeted drug delivery into prostatic, urethral and ureteral stents. Potential exists for the delivery of antibiotics into the prostate in cases of prostatitis, hormone or chemotherapy into the prostate for prostate cancer, alpha-blockers, anticholinergics, muscle relaxants, or 5-alpha reductase inhibitors for the treatment of BPH, and steroids, anti-inflammatories, or NSAIDS into obstructed ureters.

Lastly, a discussion of 11 posters was performed with highlights including a review of the trends away from TURP to minimally invasive therapies for LUTS in the US by Sean Elliot from Minnesota, 3 papers that discussed lower urinary tract symptoms after prostate brachytherapy, and five papers dealing with ureteral stenting.

It was also announced that the symposium will continue to meet on a biannual basis at each SIU.

Reported By UroToday.com Contributing Editor Michael J. Metro, M.D.

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