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

doi:doi:10.1038/sj.sc.3102011

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 Coruña, 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% (P<0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm³ (P=0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P=0.039). The urodynamic study showed an average reduction of 44.36 cm H₂O in the maximum detrusor pressure (P<0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P=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.

Keywords:

spinal cord injury, neurogenic bladder, urethral sphincter stent, urethral prosthesis, treatment of detrusor external sphincter dyssynergia

Original Article