REVERSIBLE CLINICAL OUTCOME AFTER SPHINCTER STENT REMOVAL

Purpose: We determined whether the self-expanding sphincter stent, a p otential alternative to conventional external sphincterotomy for the t reatment of detrusor external sphincter dyssynergia, causes a permanen t effect on the lower urinary tract. Materials and Methods: Four spina l cord injured men with voiding symptoms of detrusor external sphincte r dyssynergia as noted by complete urological evaluation, including a video urodynamic study, were treated with the self-expanding sphincter stent. However, the device was explanted 6 months or longer after ins ertion in all 4 cases due to stent migration (3) and difficulty with c ondom catheter urinary drainage (1). Results: All stents were removed completely without damage to the urethra. Mean voiding pressure decrea sed from 62.5 +/- 39.4 to 20.7 +/- 6.5 cm. water after sphincter stent placement. One year after stent explantation mean voiding pressure re mained unchanged from preoperative values of 58.5 +/- 21.5 cm. water. No patient had stress urinary incontinence or endoscopically apparent urethral strictures. Conclusions: The stent can be removed even after complete epithelialization and an extended interval without damage to external sphincter function or urethral stricture formation. The urina ry sphincter stent is an effective, reversible treatment for patients with detrusor external sphincter dyssynergia.