We have read with great interest the review article

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

SS Mehta and PR Tophill: Spinal Cord. 2005 Jul 26

We are in agreement with the final conclusions of the reviewers and have reported similar findings in the 7-year follow-up of our patients.1 Nonetheless, some of our patients find sphincterotomy a destructive and nonreversible option even when informed about the complications of sphincter dyssynergia. This is more so for incomplete spinal cord injury patients who void on dependable urge and manage to leave <10% residual volumes and do not desire catheterisations in any form. In such cases, we have continued to perform this procedure with caution and insist on regular follow-up.

However, one of our patients (T2 incomplete with poor hand coordination) was lost to follow-up for 2 years and presented with large bladder stone engulfing and extending through the Memokath stent (Figures 1 and 2). Contrary to our expectations this stone was very hard and required removal by cystolithotomy. On full recovery (Figure 3) the patient was unable to generate sufficient bladder pressures, attributed to cystotomy incision, to empty efficiently through the stent. This dilemma was solved by placement of supra pubic catheter, which had a significant impact on patient's quality of life due to change in his bladder management.

Figure 1
figure 1

Bladder stone with the impacted Memokath stent extending into the urethra

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Figure 2
figure 2

Urethral stricture with impacted Memokath stent

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Figure 3
figure 3

Complete stone clearance

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We cannot stress more the importance of regular follow-up of patients with Memokath stents and now also include a possibility of future bladder management change, which may not be preferred by patients in the consent for stenting.