Intraurethral stent prosthesis in spinal cord injured patients with sphincter dyssynergia

García, F.J.; Salvador, Sebastián; Montoto, Antonio; Lion, S; Balvis, B; Rodríguez, Andrés Mauricio Quevedo; Fernández, Marita Lardón; Sánchez, JM

doi:10.1038/sj.sc.3100725

Cited by 13 publications

(9 citation statements)

References 21 publications

(3 reference statements)

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“…Garcia et al 47 reported on the use of the Memotherm stent in 24 spinal cord injured men with DSD. Nine had undergone previous sphincterotomy.…”

Section: Balloon Dilatation and Stentsmentioning

confidence: 99%

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

Reynard¹,

Vass²,

Sullivan³

et al. 2002

Spinal Cord

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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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“…Garcia et al 47 reported on the use of the Memotherm stent in 24 spinal cord injured men with DSD. Nine had undergone previous sphincterotomy.…”

Section: Balloon Dilatation and Stentsmentioning

confidence: 99%

“…In the 18 with correct stent placement mean LPP decreased from 90 to 35 cm H 2 O. 47 Sauerwein et al 48 used the UroLume Wallstent in 51 patients with SCI and DSD. The patients were followed for between 12 ± 36 months.…”

Section: Balloon Dilatation and Stentsmentioning

confidence: 99%

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

Reynard¹,

Vass²,

Sullivan³

et al. 2002

Spinal Cord

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“…Percentages vary a lot between series, varying between 7.7 and 71.4%. 10,11,19,22,25,28 There is an increase in this complication as the follow-up period is extended.…”

Section: Discussionmentioning

confidence: 99%

“…Our experience in this field of studying 24 patients for an average time of 15.4 months has already been reported. 19 We now present a higher number of patients and a long-term follow-up.…”

Section: Methodsmentioning

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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“…Several different urethral stent designs have been tested in various trials including the UroLume ® (American Medical Systems, Minnetonka, MN, USA) (Chancellor et al, 1999b), Memokath ® (Doctors & Engineers A/S Ltd., Kvistgaard, Denmark) (Low and McRae, 1998;Hamid et al, 2003), Memotherm ® (Bard Corp., Covington, GA, USA) (Juan Garcia et al, 1999) and Ultraflex ® (Boston Scientific Corp., Natick, MA, USA) (Chartier-Kastler et al, 2000). The UroLume, Memotherm and Ultraflex are flexible wire mesh tubes while the Memokath is a helically wound wire.…”

Section: Urethral Stentsmentioning

confidence: 99%

Control of urinary bladder function with devices: successes and failures

Gaunt

Procházka

2006

Progress in Brain Research

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Intraurethral stent prosthesis in spinal cord injured patients with sphincter dyssynergia

Cited by 13 publications

References 21 publications

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

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

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

Control of urinary bladder function with devices: successes and failures

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