Prostatic stent test (PST) might help to select patient for benign prostatic obstruction (BPO) surgery, in neurologic patients or cases where the causal implication of prostatic adenoma is unclear. However, there is scant evidence regarding its diagnostic performances and predictive value. The aim of this study was to assess the diagnostic performance and predictive value of the PST.

The charts of all patients who underwent a PST at a single academic center between 2015 and 2021 were retrospectively reviewed. The prostatic stent test was used before BPO surgery in neurologic patients or in non-neurologic patients with unclear involvement of the prostate in the LUTS genesis. The primary endpoint was the improvement of LUTS subjectively reported by patients at the end of the PST, and 3 months after PST. Diagnostic performance for LUTS improvement, resumption of spontaneous voiding (if previous chronic urinary retention), and urinary incontinence after BPO surgery were also assessed.

Fourty patients were included, twenty-eight of which had a neurological disease. Median duration of the PST was 97 days. Only one stent complication occurred (migration : 2.5%), and 4 acute urinary retention (10%). Stent was not tolerated in 7 patients (17,5%). Twenty patients (50%) underwent a BPO surgery, three of whom had not been improved by PST. Other patients underwent OAB treatment (n=11 ; 27.5%), or self-intermittent catheterization (n=5 ; 12.5%) or indwelling supra-pubic catheter. Sensitivity and specificity of the PST for de novo incontinence after BPO surgery were respectively 50 % and 70 %. None of the patients without urinary incontinence during the PST developed urinary incontinence after BPO surgery. Sensitivity for spontaneous voiding resumption after BP surgery was 100%. Sensitivity and specificity were respectively 94.1% and 66.7% for LUTS improvement).

Patients who underwent PST, had a low rate of complications. Moreover, prostatic stent is pretty well tolerated. PST shows very good sensitivity rate for LUTS improvement and spontaneous voiding  resumption after BP surgery. Diagnostic performances of PST were better than prostatic volume, endoscopic prostatic aspect and bladder outlet obstruction index on pressure-flow studies for LUTS improvement (figure).

PST might be a promising tool to select patients for a prostatic adenoma surgery in patients with neurological diseases or for unclear cases. However, its specificity and its diagnostic performance fort post-operative incontinence seems unperfect. Moreover, our methodology could not allow us to evaluate the rate of false negatives. Further studies with a larger number of patients are needed to elucidate  the benefits of PST.