Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience

Abstract

thermosensitive stent as a 'nondestructive' means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury. Setting: Spinal Injuries Unit, Sheffield, England. Methods: A medical records review was performed to examine our experience of Memokaths over the last 10 years. During this time, 29 patients with spinal cord injury (17 tetraplegic and 12 paraplegic) underwent stenting of the external urethral sphincter either for prevention of dysreflexic symptoms, high residual urine volumes and subsequent urinary tract infection (UTI) or for protection of the upper tracts. Results: A total of 33 stents were inserted into 29 men (25-77 years) with suprasacral spinal cord injury. Initial results showed that the Memokath was effective in almost all for relief of dysreflexic symptoms and elimination of DSD on pressure flow urodynamics. However, to date, 30 of the 33 stents have been removed. The overall mean working life of the Memokath was 21 months. Four stents were removed electively and 23 for complications, which included stent migration (seven) and blockage (14). Single-ended stents were more prone to migration, which was rare after 1 year (1-13 months, median 3 months, mean 5.5 months). Stent blockage by encrustation or prostatic ingrowth did not occur before 12 months (12-45 months, median 30, mean 27.9 months). Conclusions: In selected patients, temporary, thermo-expandable (Memokath) stents are effective in the treatment of DSD. The 'working life' of a Memokath stent is 21 months; however, complications do occur which may necessitate removal. Our overall experience with Memokath stents was disappointing. In future, Memokath stents will only be inserted after careful consideration in patients with prior 'failed' transurethral sphincterotomy or with caution in patients suitable for reconstructive surgery.

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

“…20 Other authors included patients with failed sphincterotomy in their analyses, but did not analyze this subgroup separately. 21,22 Thus, our study seems to be the first evaluation of Memokath stents specifically in patients after sphincterotomy failure.…”

Long-Term Outcomes of External Sphincterotomy in a Spinal Injured Population

“…There is evidence that the majority of stent removals are performed within 2 years of insertion. 18,19 Other more invasive methods available for managing DSD in SCI patients include ileovesicostomy or cystectomy. 20,21 No patients at our institution underwent either procedure particularly as ileovesicostomy has only recently become an alternative.…”

Résultats à moyen terme du traitement de la dyssynergie vésicosphinctérienne par sphinctérotomie prothétique permanente

“…Seules demeurent les endoprothèses à spire jointive temporaires Memocath ® (Bard) et Diabolo ® (Coloplast-Porges). Ces prothèses peuvent être utiles à la sélection des patients candidats à une sphinctérotomie [22,23]. Il faut discuter chez les répondeurs le changement itératif d'endoprothèse temporaire ou la sphinctérotomie endoscopique classique.…”