Outcome after treatment of detrusor–sphincter dyssynergia by temporary stent

Abstract

Objectives: To evaluate follow-up treatments used after treatment of detrusor-sphincter dyssynergia (DSD) by a temporary urethral sphincter stent. Materials and methods: Between February 1994 and June 2003, 147 men with a mean age of 41.3714.4 years were treated by temporary urethral stent inserted across the external sphincter for DSD. The underlying neurologic disease was quadriplegia in 85 cases, multiple sclerosis in 24 cases and paraplegia in 21 cases. A Nissenkorn (Bard) stent was used in 130 cases and a Diabolo (Porgès) stent was used in 17 cases. All patients were either unable to or they refused to perform intermittent selfcatheterization. DSD was demonstrated by urodynamic studies in every case. Results: The mean duration of temporary stenting was 10.15716.07 months. After temporary stenting, 92 patients were treated by permanent stent (Ultraflex, Boston Scientifics), 7 started intermittent self-catheterization, 12 had repeated changes of the temporary stent, 4 had an indwelling catheter, 3 underwent cystectomy with non-continent diversion, 2 were treated by endoscopic sphincterotomy, 1 was treated by bladder neck incision, 1 was treated by neuromodulation and 1 was treated by cystostomy. Fifteen patients were lost to follow-up. Two patients died during follow-up (not related to DSD). Conclusion: After treatment of DSD by a temporary urethral sphincter stent, 70.7% of patients subsequently require a permanent urethral sphincter stent. This period allows selection of patients unlikely to benefit from permanent urethral sphincter stent.

Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

“…Two types of BND have been described, which may differ between tetraplegia and paraplegia: one is secondary to AD and the other is associated with loss of supraspinal inhibitory control on the vesico-sympathetic reflex. 19 Vesicoureteral reflux is known to improve after surgical sphincterotomy or urethral stenting, 3,9 or urethral injection. 8,13 Our study confirms this, as reflux was found to have disappeared in all patients who underwent repeat cystourethrograms.…”

“…Sphincteric stenting is another option with a satisfactory success rate of 75% at 3 months; however, this technique is also associated with short-and long-term complications. 9 The reasons for the failure of botulinum toxin injections are not fully understood: detrusor underactivity, 1 bladder neck dyssynergia (BND), 1,7 type of DSD and the dose or dilution of the toxin 10 have been suggested to affect effectiveness. However, few studies have been carried out, and the samples included are generally small.…”

Clinical Usefulness of the Memokath Stent as a Second-Line Procedure After Sphincterotomy Failure

“…If a temporary stent ensured effective bladder emptying, a permanent stent was used. 23 Until today, however, no perfect permanent stent exists, because in longterm follow up, permanent stents caused significant problems in a significant proportion of patients. Urothelial ingrowth can be a long-term problem, leading to recurrent endoscopic resections.…”

Résultats à moyen terme du traitement de la dyssynergie vésicosphinctérienne par sphinctérotomie prothétique permanente

“…Seules demeurent les endoprothèses à spire jointive temporaires Memocath ® (Bard) et Diabolo ® (Coloplast-Porges). Ces prothèses peuvent être utiles à la sélection des patients candidats à une sphinctérotomie [22,23]. Il faut discuter chez les répondeurs le changement itératif d'endoprothèse temporaire ou la sphinctérotomie endoscopique classique.…”