Outcome of Dual Flange Metallic Urethral Stents in the Treatment of Neuropathic Bladder Dysfunction After Spinal Cord Injury

Abstract

In total, 33 stents were placed in 28 male patients. SCI was cervical in 23 patients and thoracic in 5. Average follow-up was 18 months (range 1-40 months, median 18 months). The most common indications were repeated catheter blockage in eight patients and urinary tract infection in six. The average time from SCI to stent insertion was 79 months (range 1-468 months, median 21 months). Severe autonomic dysreflexia was present in 17 cases before stent placement and in 7 after stents were placed (P=0.003). Stents failed in 15 patients (45%) and were removed. The most common reason for failure was stone formation. Comparing the group of patients with stents lasting >20 months (n=11) to the group with stent removal before 20 months (n=10), the mean time between SCI and stent placement was 31 vs 119 months (P=0.057). Medium term results (up to 27 months) were significantly influenced by earlier stent placement (P=0.0484). One major complication was stent migration that caused an urethrocutaneous fistula.

Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction

“…Reported outcomes are mostly short-term,[ 24 25 26 ] but some long-term studies report up to 13% reduction in AD episodes. [ 24 ] Complications include bladder neck obstruction/stenosis (3.5-42%), stent migration (5-33%), calculi (6-20%), and stent telescoping (16-25%).…”

“…[ 24 ] Complications include bladder neck obstruction/stenosis (3.5-42%), stent migration (5-33%), calculi (6-20%), and stent telescoping (16-25%). [ 24 26 27 ]…”

Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury

“…Unfortunately, intraurethral stents do not seem to be equal to or superior to a sphincterotomy. In suprasacral SCI patients who underwent intraurethral stents over sphincterotomy, urinary tract stones and intraurethral stent migration were the most common complications, with 15 out of 33 stents removed by 18 months on average [ 54 ].…”

Surgical management of the neurogenic bladder after spinal cord injury

“…Though the first results with urethral stent as an alternative to conventional endoscopic sphincterotomy seemed promising [28], long-term results were not as satisfactory. Common complications are device migration, bladder neck obstruction, intravesical stone formation, encrustation, granulation tissue ingrowth, increase in AD and obstruction [29]. A temporary stent can be used in patients planning fertility treatment or in patients where the consequences of eventual sphincterotomy need to be better explored.…”