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The mesh wallstent in the treatment of detrusor external sphincter dyssynergia in men with spinal cord injury: a 12‐year follow‐up
Author(s) -
Hamid R.,
Arya M.,
Patel H.R.H.,
Shah P.J.R.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04009.x
Subject(s) - medicine , dyssynergia , spinal cord injury , autonomic dysreflexia , detrusor sphincter dyssynergia , surgery , stent , clean intermittent catheterization , urethra , urethral sphincter , anesthesia , urology , sphincter , spinal cord , urinary bladder , psychiatry
OBJECTIVE To assess the long‐term effectiveness of the UroLume™ wallstent (Pfizer Inc., UK) in the treatment of detrusor external sphincter dyssynergia (DESD) in quadriplegic patients. PATIENTS AND METHODS Twelve patients with quadriplegia secondary to spinal trauma underwent external striated sphincter stenting with the UroLume wallstent instead of an external sphincterotomy for DESD (mean age 41.8 years, range 26–65). The level of injury was C4 in two, C5 in four, C6 in four, C7 in one and T6 in one. All patients were shown by preoperative video‐cystometrography (VCMG) to have DESD and high‐pressure, hyper‐reflexic bladders with incomplete emptying. RESULTS Seven of the 12 patients had a mean (range) follow‐up of 12.7 (12.17–13.6) years; two others were lost to follow‐up at 1 and 3 years and both remained free of complications during that time. Two patients developed encrustation causing obstruction, requiring stent removal within a year of insertion. Another patient with an adequately functioning stent died 7 years after surgery (chest infection). Urodynamic follow‐up of the seven patients showed a significantly sustained reduction in maximum detrusor pressure and duration of detrusor contraction at> 10 years of follow‐up. Five of the seven patients developed bladder neck dyssynergia of varying degrees, as shown on VCMG; all were successfully treated with bladder neck incision. There were no problems with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia. CONCLUSION Permanent urethral stenting using the UroLume wallstent is effective in managing DESD and provides an acceptable long‐term alternative to sphincterotomy. Subsequent bladder neck dyssynergia is the main complication but this can be managed successfully with bladder neck incision. Importantly, unlike sphincterotomy, there is no significant interference with erectile function. Also, the procedure is reversible, minimally invasive and requires a shorter hospital stay.