URETHRAL STENT FOR THE TREATMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA: EVALUATION OF THE CLINICAL, URODYNAMIC, ENDOSCOPIC AND RADIOLOGICAL EFFICACY AFTER MORE THAN 1 YEAR

Abstract

We studied the intermediate-term clinical, urodynamic, endoscopic and radiological efficacy of the Ultraflex urethral stent (Boston Scientific Co., Boston, Massachusetts) for the treatment of detrusor-sphincter dyssynergia (DSD) in spinal cord injured patients. A total of 47 consecutive men presenting with DSD due to spinal cord injury (39) or various spinal cord diseases (9) were treated with the Ultraflex stent. DSD was demonstrated by urodynamic assessment with electromyographic recording of the striated urethral sphincter muscle activity. Postoperatively, all patients voided by reflex. The number of patients with symptomatic postoperative urinary tract infection decreased significantly (p <0.001). Urodynamic assessment (mean followup +/- SD 2.2 +/- 1.3 years) showed reduction of mean peak detrusor pressure from 65.7 +/- 27.8 to 46.4 +/- 28.8 cm H2O (p <0.005) and reduction of mean residual urine from 231.6 +/- 168.1 to 70.3 +/- 85.6 ml (p <0.0005). Mean urethral closing pressure was markedly reduced from 73.9 +/- 40.9 to 23.8 +/- 25.1 cm H2O (p <0.0005). Mean endoscopic followup was 1.7 +/- 1.1 years. Mean percentage of epithelialization was 90.8% +/- 19.7%, and no obstructive granulation tissue or stone encrustation was observed inside the stent. On ultrasound signs of hydronephrosis persisted in only 1 of 8 patients. There were no immediate postoperative complications. Complementary bladder neck incision was performed in 21% of patients. The Ultraflex stent appears to be effective for intermediate-term treatment of DSD on the basis of clinical, urodynamic, endoscopic and radiological parameters.