Procedures
ITIND remodeling treatment for benign prostatic hyperplasia
ITIND remodeling treatment for benign prostatic hyperplasia
In a nutshell, this treatment for benign prostatic hyperplasia (BPH) is delivered in a single session lasting around 15 minutes. The device is in place for 7 days, and 2 days after treatment the patient can resume normal activities.
Setting up ITIND treatment
The ITIND is a nitinol device (composed of roughly equal parts nickel and titanium, and which is an advanced material in some medical devices) temporarily implanted in the urethra. This reshapes the prostatic part and the neck of the bladder to effectively and sustainably relieve the symptoms of BPH (link to https://www.lescliniquesmaroisurologue.ca/en/diagnostics/prostate-hyperplasia/) – all without heating the prostate tissue.
Through continued pressure and subsequent ischemia, ITIND spacers reshape the prostatic urethra and bladder neck, recreating a channel to allow better urine flow. The device is kept in place for 5-7 days, after which it is completely removed.
The ITIND can be placed in an office using a thin rigid or flexible cystoscope and patients are able to go home the same day.
Images courtesy of Olympus
What are the selection criteria for this treatment?
- All ages
- Dissatisfaction with drug therapy
- Prostatic volume <60mL
- No obstructive median lobe (IPP <1)
- Good detrusor function
How does the ITIND intervention take place?
During the procedure, the ITIND device will be temporarily implanted into your prostate through a thin tube and positioned using a tiny camera.
After implantation of the ITIND, most patients experience an increase in urine output and can go home without a catheter. If you cannot urinate after the procedure, a catheter may be placed temporarily to help relieve your bladder. You will usually go home a few hours after the procedure. We advise you to have someone drive you home after the procedure.
For 5-7 days, you will have a suture running from the device and out of your penis. The suture will be attached to the shaft of your penis. DO NOT CUT OR DAMAGE THE SUTURE THREAD. Suture will be used to facilitate removal of the device.
What should be expected while ITIND is in place?
- Slight burning during urination.
- Presence of a little blood in the urine and possibly small clots. This problem usually resolves within the first 2-3 days after device implantation.
- It is recommended that you wear an absorbent pad in your underwear to manage any moisture that may leak from the retention suture to your underwear or clothing during the implant period.
- Increased frequency and desire to urinate. The device will put pressure on the area where your bladder meets your prostate; this sensation is usually felt most strongly for the first 2 or 3 days, after which it begins to subside.
- The feeling of pressure and the presence of a foreign body in the area of your perineum. Most patients experience it as a bit uncomfortable, especially when sitting on a hard surface. Resting in a recliner-type chair can minimize discomfort. Some patients experience more than mild to moderate discomfort, and your doctor may prescribe painkillers and anti-inflammatories to help relieve symptoms.
- You may be prescribed an antibiotic to reduce the risk of infection. It is important that you follow your urologist's advice for taking antibiotics and any other medications.
- While the device is in place, you should not engage in sexual activity or strenuous exercise. This includes heavy lifting, cycling, running, or activities such as sitting on a lawnmower or working with vibrating equipment.
What is the removal procedure for the ITIND device?
Most patients experience immediate symptom relief upon removal of the device and have good urinary flow. Although rare, if you are unable to urinate at the end of the procedure, a catheter may be placed temporarily to help you empty your bladder.
As for the implantation, you can leave the clinic after the removal and have urinated well.
You can resume your normal activities 1-2 days after removal of the device.
Mild episodes of blood in the urine are possible for a few days to a week after the procedure, but they resolve on their own.
What if another procedure is needed?
As the ITIND is not a permanent implant, all alternative treatments can be considered in the future.
Will the procedure have an effect on my sexuality?
The ITIND is designed to preserve the integrity of the sphincters and sperm ducts. Clinical studies have shown that following the ITIND procedure, patients will experience no change in ejaculatory and erectile functions.
What are the benefits of ITIND treatment?
Clinical data demonstrates that the ITIND provides durable results for quality of life (demonstrated by IPSS questionnaire) and urine output (Qmax on flowmetry) for the treatment of BPH. Studies with the first generation prototype show lasting results three years later, and at least one year using the latest version of ITIND (study in progress):
- Fast and effective relief of BPH symptoms
- Preservation of sexual function and ejaculation
- Rarely need a catheter after treatment
- Safe
- Good treatment alternative to prescription medication for BPH
- Adequate treatment in case of a high bladder neck