title: [Treatment of detrusor-striated sphincter dyssynergia with permanent nitinol urethral stent: results after a minimum follow-up of 2 years].
abstract: OBJECTIVE
  The aim of this study was to assess the outcomes of nitinol permanent urethral stents used in detrusor-striated sphincter dyssynergia (DSD) treatment on male patients with a spinal cord injury.
  
  
  METHODS
  We investigated retrospectively all patients treated from 2004 to 2012. A total of 22 patients were included, with an age ranging from 22 to 76 years old. The DSD syndrome was due to spinal cord injury (18) or various spinal cord diseases (four) and treated with a nitinol urethral stent (11 Ultraflex(®) and 11 Mémotherm(®)). Every patient had an urodynamical study. The follow-up reached at least 2 years.
  
  
  RESULTS
  The mean follow-up was 56 months (± 14). Complementary procedures after stenting included: five stent prolongation or displacement (mean interval 7.6 months), six bladder neck incisions (12.2 months), three urethrotomy (42 months), ten obstruction treated by laser (47.3 months). Eight patients had a change of their urinary pattern: four underwent ileal conduit diversion, one had a continent urinary diversion, one chose self intermittent catheterization, two were under indwelling catheterization waiting for another treatment. Stent retrieval was either harmful or impossible for four of them. Three patients were free of complementary procedures.
  
  
  CONCLUSIONS
  Nitinol urethral stent was an effective treatment initially. However, by the third year, urethral stenosis and hypertrophic growth of the urethral mucosa usually require iterative endoscopic procedures (0.31 per patient per year). Patients treated with permanent uretral stent deserve a yearly endoscopic follow-up. Safety and effectiveness of permanent uretral stent compared to surgical sphincterotomy to treat DSD are discussed.
authors.affiliation: Service d'urologie, hôpital Gabriel-Montpied, université d'Auvergne, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France.
authors.forename: T
authors.initials: T
authors.lastname: Polguer
authors.forename: R
authors.initials: R
authors.lastname: Boissier
authors.forename: S
authors.initials: S
authors.lastname: Gaillet
authors.forename: K
authors.initials: K
authors.lastname: Lenne Aurier
authors.forename: P-H
authors.initials: PH
authors.lastname: Savoie
authors.forename: E
authors.initials: E
authors.lastname: Lechevallier
authors.forename: C
authors.initials: C
authors.lastname: Coulange
authors.forename: G
authors.initials: G
authors.lastname: Karsenty
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D015607:Stents; D013997:Time Factors; D014521:Urethra; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
chemical_list: D000497:Alloys; C013616:nitinol