A urethral stent for the treatment of detrusor-striated sphincter dyssynergia

被引:32
作者
Chartier-Kastler, EJ
Thomas, L
Bussel, B
Chancellor, MB
Richard, F
Denys, P
机构
[1] Univ Paris 06, Pitie Salpetriere Hosp, Dept Urol, Paris, France
[2] Univ Paris Ouest, Raymond Poincare Hosp, Dept Neurol Rahabil, Paris, France
[3] Univ Pittsburgh, Sch Med, Neurourol Program, Pittsburgh, PA USA
[4] Univ Pittsburgh, Sch Med, Urinary Incontinence Program, Pittsburgh, PA USA
关键词
urethral stent; detrusor-sphincter dyssynergia; bladder; neurogenic; spinal cord injury; urodynamics;
D O I
10.1046/j.1464-410x.2000.00720.x
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
Objective To assess the technique, efficacy and complications of the Ultraflex(R) urethral stent (Boston Scientific Corp., Boston, MA) for the treatment of detrusorstriated sphincter dyssynergia (DSD). Patients and methods Forty consecutive patients with DSD who had a Ultraflex(R) stent placed in the membranous urethra were evaluated prospectively, DSD was caused by spinal cord injury in 30, multiple sclerosis in six and other neurological diseases in four. All patients were either tetraplegic or paraplegic and unable to use intermittent self-catheterization. Previous bladder management consisted of an indwelling catheter in 15 patients, chronic suprapubic catheters in two, intermittent catheterization in nine. and trigger reflex micturition in 14. The Ultraflex stent was placed under local anaesthesia. The stents were 50 mm long in 36 patients, 45 mm in two and 40 mm in two. The mean (SD) follow-up was 16.9 (13.8) months. Results The mean (SD) residual urine decreased from 245.9 (117) mL before stenting to 65.2 (19.3) mL at 12 months afterward (n = 19). One stent was removed at 13 months for chronic prostatic and urinary tract infection leading to autonomic dysreflexia. There was no stent stenosis and 17 of 18 stents had >75% epithelial coverage at one pear. None of the stents migrated. Seven patients underwent secondary bladder neck incision through the stent. The stent length was increased in four patients using a second overlapping distal stent, twice during the first procedure and twice within 6 months because the sphincter was inadequately covered. Conclusions The Ultraflex(R) stent achieved the expected results for a prosthetic sphincterotomy and appears to be an appropriate but less invasive treatment for DSD.
引用
收藏
页码:52 / 57
页数:6
相关论文
共 15 条
[11]   LASER SPHINCTEROTOMY AND ABLATION OF THE PROSTATE USING A SAPPHIRE CHISEL CONTACT TIP FIRING NEODYMIUM-YAG LASER [J].
PERKASH, I .
JOURNAL OF UROLOGY, 1994, 152 (06) :2020-2024
[12]   PROSPECTIVE COMPARISON OF EXTERNAL SPHINCTER PROSTHESIS PLACEMENT AND EXTERNAL SPHINCTEROTOMY IN MEN WITH SPINAL-CORD INJURY [J].
RIVAS, DA ;
CHANCELLOR, MB ;
BAGLEY, D .
JOURNAL OF ENDOUROLOGY, 1994, 8 (02) :89-93
[13]   Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: A prospective study in 24 spinal cord injury patients [J].
Schurch, B ;
Hauri, D ;
Rodic, B ;
Curt, A ;
Meyer, M ;
Rossier, AB .
JOURNAL OF UROLOGY, 1996, 155 (03) :1023-1029
[14]   IS SPHINCTEROTOMY THE BEST MANAGEMENT OF THE SPINAL-CORD INJURED BLADDER [J].
VAPNEK, JM ;
COUILLARD, DR ;
STONE, AR .
JOURNAL OF UROLOGY, 1994, 151 (04) :961-964
[15]   DYSYNERGIC VESICOURETHRAL RESPONSES DURING BLADDER REHABILITATION IN SPINAL-CORD INJURY PATIENTS - EFFECTS OF SUPRAPUBIC PERCUSSION, CREDE METHOD AND BETHANECHOL CHLORIDE [J].
YALLA, SV ;
ROSSIER, AB ;
FAM, B .
JOURNAL OF UROLOGY, 1976, 115 (05) :575-579