1514 OUTCOME OF DUAL FLANGE METALLIC URETHRAL STENTS IN THE TREATMENT OF NEUROPATHIC BLADDER DYSFUNCTION AFTER SPINAL CORD INJURY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20111514 OUTCOME OF DUAL FLANGE METALLIC URETHRAL STENTS IN THE TREATMENT OF NEUROPATHIC BLADDER DYSFUNCTION AFTER SPINAL CORD INJURY Andre Van der Merwe, Ed Baalbergen, Ray Shrosbree, and Chris Heyns Andre Van der MerweAndre Van der Merwe Cape Town, South Africa More articles by this author , Ed BaalbergenEd Baalbergen Cape Town, South Africa More articles by this author , Ray ShrosbreeRay Shrosbree Cape Town, South Africa More articles by this author , and Chris HeynsChris Heyns Cape Town, South Africa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1493AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To audit the results of metallic urethral stents used in patients with spinal cord injury (SCI). The bladder management after spinal cord injury (SCI) may determine the life expectancy of these patients, because the second leading cause of death (after respiratory causes) is urinary tract complications. Renal failure may follow vesico-ureteric reflux caused by highpressure neurogenic bladder dysfunction. METHODS We performed a case note review of dual flange Memokath™ stents placed from March 2008 until April 2010. Inclusion criteria were: (1) severe autonomic dysreflexia, (2) repeated catheter blockage, bladder stones, urinary tract infection (UTI), (3) prevention of upper urinary tract damage, if signs of severe bladder hostility were seen on urodynamic study (UDS) or cystography, coupled with symptoms of autonomic dysreflexia. Patients received, under deep general anaesthesia, a thermo-sensitive expandable metallic stent which was positioned over the internal and external urethral sphincters. The stent was expanded by irrigating it with warm saline when seen in position on X-ray fluoroscopy. RESULTS In total, 21 stents were placed in 19 male patients. The most common length stent was 6 cm (range 4–7cm). SCI was cervical in 16 patients and thoracic in 3. Average age of the patients was 35 years. The most common cause of spinal cord injury (SCI) was motor vehicle accident (MVA). Average follow-up time was 15 months (5–25). The most common indication was repeated catheter blockage and -UTI (8). The median time to stenting post-SCI was 21 months (1–468). Average detrusor pressure (Pdet) on pre-operative UDS was 65 cm H2O. Severe autonomic dysreflexia was present in 13 cases. Stents failed in 6 patients (31%) and were removed. Most common reason for failure was poor drainage with UTIs (5 cases). Two patients with failed stents had flaccid bladders pre-operatively. Median time to placement of stents that subsequently failed was 72 months and median time to placement of stents that were successful was 20 months. One major complication was stent migration that caused a urethra-cutaneous fistula. CONCLUSIONS Metallic stenting in SCI related neuropathic bladder dysfunction is a minimally invasive, reversible procedure with acceptable success and complication rates. Earlier placement during SCI evolvement may be associated with better outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e607 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Van der Merwe Cape Town, South Africa More articles by this author Ed Baalbergen Cape Town, South Africa More articles by this author Ray Shrosbree Cape Town, South Africa More articles by this author Chris Heyns Cape Town, South Africa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...