Placement of a wire mesh prosthesis in the external urinary sphincter of men with spinal cord injuries.
The authors report their experience with an intraurethral prosthetic stent as an alternative treatment for detrusor-external urethral sphincter dyssynergia (DESD). A sphincter prosthesis was inserted into the membranous urethra of 25 men with spinal cord injuries, DESD, and elevated voiding pressure. Bladder voiding pressure decreased from 87 cm H2O +/- 23 to 27 cm H2O +/- 11 in 12 months (P < .001). There was a significant decrease in residual urine volume 12 months after prosthesis placement, from 122 mL +/- 77 to 33 mL +/- 19 (P < .01); bladder capacity remained relatively unchanged, from 174 mL +/- 84 to 230 mL +/- 92 (P < .57). No deleterious effects were seen in renal or erectile function. Migration of three prostheses occurred 1 day to 6 weeks after insertion. One additional complication, pyelonephritis, occurred in a patient with preexisting vesicoureteral reflux, necessitating reimplantation of bilateral ureters. The intraurethral wire mesh prosthesis, with its simplicity of placement and minimal associated morbidity, offers a potential alternative to external sphincterotomy.
Chancellor
M B
MB
Department of Urology, Jefferson Medical College, Philadelphia, PA 19107.
Karusick
S
S
Erhard
M J
MJ
Abdill
C K
CK
Liu
J B
JB
Goldberg
B B
BB
Staas
W E
WE
D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D013119:Spinal Cord Injuries / Q000150:complications*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D016055:Urinary Retention / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial