Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia

Abstract

Study design: Retrospective study. Objectives: To assess in the long-term clinical and urodynamic results of intraurethral stents in a group of patients with spinal cord injury. Setting: Spinal Cord Injury Unit, Juan Canalejo Hospital, A Corun˜a, Spain. Methods: Forty-seven consecutive male patients were studied from 1993 to 2002. All of them suffered from hyperreflexia with detrusor-sphincter dyssynergia (DSD) owing to spinal cord injury, and were treated by means of the placement of an intraurethral stent at the external sphincter. Results: After surgery, significant decreases in all the parameters studied were observed. The number of patients with symptoms of urinary tract infection decreased by 25% (Po0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm 3 (P ¼ 0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P ¼ 0.039). The urodynamic study showed an average reduction of 44.36 cm H 2 O in the maximum detrusor pressure (Po0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P ¼ 0.013). The most frequent stent complication was displacement, followed by stenosis, lithiasis and intraprosthetic calcification. In all, 8.5% required the stent removal. Conclusions: Intraurethral stent is a good choice for the long-term management of DSD in spinal cord-injured patients, even in those who had been previously submitted to prior sphincterotomy. It has the advantage of being a potentially reversible procedure, so patients prefer it to more invasive therapies such as sphincterotomy.

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

“…Studies comparing the success of sphincterotomy, either as an irreversible surgical procedure or as a reversible treatment with botulinum toxin A injection [9] or placement of urethral stents [10] , have used variable outcome criteria. Reduction of residual urine has frequently been used for this purpose.…”

Forty-five-year follow-up on the renal function after spinal cord injury

“…Although the results are comparable with sphincterotomy and the stenting procedure has a shorter surgery time and reduced hospital stay (156,157), the costs (1) and possible complications or re-interventions (156,158,159) are limiting factors in its use.…”

Clinical Usefulness of the Memokath Stent as a Second-Line Procedure After Sphincterotomy Failure

“…Urothelial ingrowth can be a long-term problem, leading to recurrent endoscopic resections. 24,25 In addition, removal of these stents can be extremely difficult. 22,25 Despite encouraging short-term results, the long-term results of Memokath stents were disappointing.…”