We report on the intraurethral insertion of the Memokath in 24 patients (26 stents) to combat detrusor-sphincter dyssynergia developing after spinal cord injury. Most patients have high tetraplegia for whom self-catheterisation is very difficult, if not impossible. Our results have been disappointing in that 19 stents have had to be removed, mainly because of persisting urinary infection, migration of the stent, or because of failure to improve emptying, usually associated with poor detrusor function. Caution is therefore advised in the use of this stent for detrusor-sphincter dyssynergia and it is not recommended in patients with chronic urinary infection. With better patient selection however, perhaps aided by modifications to stent design, the Memokath may still prove to be a simple and reversible alternative to sphincterotomy in this difficult group of patients.
Clam enterocystoplasty has proved to be the most effective treatment for severe detrusor instability resistant to conservative treatment (Bramble, 1982; Mundy and Stephenson, 1985). More recently it has become the procedure of choice in patients with neuropathic bladders with hyper-reflexia or severely impaired compliance, provided that the bladder is of reasonable size and that gross fibrosis and/or diverticular formation of the bladder wall has not occurred. Fifty-nine patients have undergone the clam procedure as part or all of their reconstruction in the past 4 years. Although uncontrolled incontinence was the commonest indication, impaired renal function was the indication in 14 patients and need for undiversion in seven. Currently all but four are voiding satisfactorily or are on intermittent self-catheterisation, though six have significant stress incontinence. The clam procedure is easier, quicker and as satisfactory as substitution cystoplasty in selected cases.
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