Feasibility of a temporary urethral stent through the striated sphincter in patients in the early phase (6 months) of spinal cord injury.
OBJECTIVE
To assess the feasibility of a temporary urethral stent through the striated sphincter in patients in the early phase (before 6 months) of spinal cord injury (SCI) in a department of neurological rehabilitation.


METHODS
Fourteen consecutive men with SCI with urinary retention within 6 months after SCI were prospectively treated. Thirteen patients were tetraplegic (C2 to C7) and 1 was paraplegic. All patients were managed with indwelling catheters (10) or intermittent catheterization (4). The Nissenkorn polyurethane urethral stent was inserted across the external sphincter under local anesthesia for an anticipated 4-month duration.


RESULTS
No perioperative complications were encountered. Hospital mean stay at the urological department was 1.9 days (range 1-4 days). All patients had good emptying of the bladder (residual urine less than 100 ml) and were free of all types of catheterization. Five stents had to be repositioned in the first 2 weeks, 1 was removed for obstruction at 2.5 months. There was no lithiasis, no upper urinary tract alteration, no symptomatic infection nor local discomfort during follow-up. At a mean of 3.7 months after implantation, 10/14 (71.5%) patients chose sphincterotomy by permanent urethral stent and 4 had stent removal for learning of self-intermittent catheterization (3) and indwelling catheter (1).


CONCLUSIONS
The temporary sphincter stent is a new, feasible and reversible technique to manage neuropathic bladder dysfunction in the early phase after SCI. A randomized study on intermittent catheterization should be conducted. It should consider patients' and nursing caregivers' evaluations.
Department of Urology, Pitié-Salpêtrière Hospital, University Pierre et Marie Curie (Paris VI), 83, boulevard de l'Hôpital, F-75013 Paris, France. emmanuel.chartier-kastler@psl.ap-hop-paris.fr
E J
EJ
Chartier-Kastler
L
L
Thomas
B
B
Bussel
M B
MB
Chancellor
F
F
Richard
P
P
Denys
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000150:complications*; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014521:Urethra; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000628:therapy*