Sphincteric stent versus external sphincterotomy in spinal cord injured men: Prospective randomized multicenter trial

被引:37
作者
Chancellor, MB
Bennett, C
Simoneau, AR
Finocchiaro, MV
Kline, C
Bennett, JK
Foote, JE
Green, BG
Martin, SH
Killoran, RW
Crewalk, JA
Rivas, DA
机构
[1] Univ Pittsburgh, Div Urol Surg, Pittsburgh, PA 15213 USA
[2] Thomas Jefferson Univ, Dept Urol, Philadelphia, PA 19107 USA
[3] Univ So Calif, Rancho Los Amigos Med Ctr, Dept Urol, Downey, CA 90242 USA
[4] Shephard Spinal Injury Ctr, Dept Urol, Atlanta, GA USA
关键词
stents; spinal cord injuries; urodynamics; urinary incontinence; urethra;
D O I
10.1016/S0022-5347(05)68837-4
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: In a prospective randomized multicenter trial we compared the treatment results of conventional external sphincterotomy with those of UroLume sphincteric stent prosthesis placement in men with spinal cord injury and external detrusor-sphincter dyssynergia. Materials and Methods: We randomized 57 men with spinal cord injury in whom urodynamics verified external detrusor-sphincter dyssynergia into 2 groups to undergo either sphincter defeating procedure. We compared the primary urodynamic parameter of maximum detrusor pressure, and secondary urodynamic parameters of bladder capacity and post-void residual urine volume in men who underwent sphincterotomy or sphincteric stent placement. Parameters were measured preoperatively, and 3, 6, 12 and 24 months postoperatively. Patients completed questionnaires regarding voiding sensation and quality of life issues at each followup visit. Results: Demographic data of the 26 patients treated with sphincterotomy and the 31 treated with sphincteric stent placement were statistically similar. Preoperatively mean maximum detrusor pressure plus or minus standard deviation in sphincterotomy and stent cases was 98.3 +/- 27.6 and 95.7 +/- 27.7 cm. water, respectively (p = 0.73). At 12 months mean maximum detrusor pressure decreased to 48.9 +/- 16.4 and 52.6 +/- 31.6 cm. water in the sphincterotomy and stent groups, respectively (p = 0). Preoperatively mean bladder capacity in sphincterotomy and stent cases was 245 +/- 158 and 251 +/- 145 mi., respectively (p = 0.87). Bladder capacity did not change significantly in either treatment group throughout followup. Preoperatively mean post-void residual urine volume in the sphincterotomy and stent groups was 212 +/- 163 and 168 +/- 114 mi., respectively (p = 0.33). Residual urine volume decreased in each group at some but not all followup evaluations. The duration of hospitalization was greater for sphincterotomy than stenting (p = 0.036). Six stents required explantation. Conclusions: The UroLume stent is as effective as conventional external sphincterotomy for treating external detrusor-sphincter dyssynergia. However, sphincteric stent placement is advantageous because it involves shorter hospitalization and is potentially reversible.
引用
收藏
页码:1893 / 1898
页数:6
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