Prostatic Balloon Dilatation in 115 Unequivocally Obstructed Patients

Abstract

We report our experience with balloon dilatation of the prostate in 115 unequivocally obstructed patients, 22% of whom had refused resection and the remainder of whom were at high risk for surgery. Almost two-thirds had not responded to alpha-blockers, and one-third were in refractory retention. We used balloon localization by palpation only, finding it safe, simple, and inexpensive. Also, spinal or general anesthesia was used in every instance, as this technique is most effective and least burdensome to limited-risk patients if they are totally comfortable. Follow-up data are available for 3 to 52 months. Of these patients, 29% required more than ambulatory treatment or one night's hospitalization, usually for their comorbidities and not the procedure itself. The dilatations were considered successful in 71% of cases, including 42% in whom the results were objectively as good as the results of a properly indicated and well-performed transurethral prostatectomy and 29% who were improved objectively and needed no further treatment. However, 10% of the patients were unchanged, and 19% of the procedures were considered failures. The main disadvantage of this technique is the inability to predict with certainty which patients will respond well. Moreover, all alternatives to prostatectomy share the common defect of providing no tissue. Common sense and thoroughness must prevail to avoid subjecting someone with curable prostatic malignancy to any of the alternatives, pharmacologic or procedural.