Use of the Memokath® for detrusor-sphincter dyssynergia after spinal cord injury – a cautionary tale

Low, A. I.; McRae, P.J.

doi:10.1038/sj.sc.3100514

Cited by 24 publications

(15 citation statements)

References 5 publications

(6 reference statements)

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“…Although initial results appeared promising, almost all the stents required removal for complications of urinary infection, migration and encrustation. 34 The 'working life' of a Memokath stent is 20-21 months.…”

Section: Discussionmentioning

confidence: 99%

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

R-Losada

Montoto-Marqués

et al. 2007

Spinal Cord

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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.

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Section: Discussionmentioning

confidence: 99%

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

R-Losada

Montoto-Marqués

et al. 2007

Spinal Cord

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“…42 Another study, however, failed to demonstrate a substantial bene®t; 19 out of 24 Memokath inserted had to be removed. 43 The authors of the study recommended caution when using the stents in DESD and not to use them in the presence of chronic urinary tract infection. (iv) Botulinum toxin injection into the external sphincter mechanism has had some success in patients with DESD.…”

Section: Operative Interventionsmentioning

confidence: 99%

Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI)

Jamil

2001

Spinal Cord

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Study design: Review. Objectives: To assess current available options for bladder management in SCI patients the post-acute phase. Methods: Relevant articles were extracted from medline and Cinahl between 1966 ± 1999. In addition, references earlier than 1966 that were listed in these articles were identi®ed and extracted. Results: Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. Conclusion: Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the ®rst half of the 20th century to the present 3%. Spinal Cord (2001) 39, 355 ± 361

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“…They advised against the use of urethral stents in those with chronic urinary tract infection. 51 Urethral stents seem to be comparable, and in some outcome measures better, than external sphincterotomy, though concerns are still expressed about the long term risk of stent encrustation and there remains a de®nite risk of stent migration necessitating stent removal or replacement. Depending on the type of stent used this can be accomplished easily or may be associated with considerable urethral trauma.…”

Section: Sonimentioning

confidence: 99%

Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects

et al. 2002

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Study design: Literature review of current treatment options for detrusor ± sphincter dyssynergia (DSD) in spinal cord injury. Objectives: To review the outcomes and complications associated with external sphincterotomy and to summarise the results and complications of alternative treatment options for detrusor ± sphincter dyssynergia in spinal cord injury. In addition, we propose a potential alternative future drug treatment for external sphincter dyssynergia based upon recent research on the neuropharmacology of the external urethral sphincter. Setting: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Methods: Medline search from 1966 to 2002 using the words`external sphincterotomy', detrusor ± sphincter dyssynergia' and`neurogenic bladder combined with surgery'. Results: While external sphincterotomy is an eective treatment for DSD, a signi®cant number of men following this procedure continue to have high intrarenal pressures, recurrent urinary infection or troublesome autonomic dysre¯exia and a worryingly high proportion demonstrate persistently raised leak point pressures, putting them at subsequent risk of renal damage. Alternative treatments for external sphincter dyssynergia include urethral stents and balloon dilatation, both of which are eective. However, over the long term stents can undergo encrustation and there remains a de®nite risk of stent migration necessitating stent removal or replacement. Balloon dilatation of the external sphincter is associated with a risk of subsequent stricture formation. Intraurethral Botulinum A toxin seems to be eective though there have been no large randomised studies comparing it against placebo. However, it is not a durable treatment option and it has not found a common place in the treatment of DSD. There is now a considerable amount of experimental data from both animal and human studies to suggest that nitric oxide (NO) is an important physiological inhibitory neurotransmitter in the urethral sphincter, mediating relaxation of the external urethral sphincter. The potential role of sphincter NO augmentation for treatment of DSD is discussed. Conclusion: External sphincterotomy remains the mainstay of treatment for urodynamically signi®cant detrusor ± sphincter dyssynergia, but in recent years a number of eective, alternative treatment options have become available. While at present there is no eective systemic drug treatment, recent research into external sphincter neuropharmacology suggests that systemic or topical augmentation of external sphincter NO may provide an eective method for lowering sphincter pressure.

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Use of the Memokath® for detrusor-sphincter dyssynergia after spinal cord injury – a cautionary tale

Cited by 24 publications

References 5 publications

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

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

Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI)

Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects

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