USE OF MEMOKATH, A 2ND-GENERATION URETHRAL STENT FOR RELIEF OF URINARY RETENTION IN MALE SPINAL-CORD INJURED PATIENTS

Memokath (Engineers & Doctors A/S, Hombaek, Denmark) a second generati on urethral stent composed of titanium nickel alloy with shape memory effect was deployed in 10 male spinal cord injured patients with urina ry retention. The stent was inserted under sterile conditions via a de livery catheter under fluoroscopic control in seven and with the aid o f a flexible cystoscope in three. The proximal end of the stent was po sitioned at the bladder neck and 50 ml of normal saline at 45-degrees- C was flushed through the stent which resulted in expansion of the dis tal most four coils of the stent in the proximal bulbar urethra; thus the internal sphincter (bladder neck) and external sphincter zone were kept open by the stent. Urethral stenting helped to achieve complete vesical emptying in all 10 patients. The complications included transi ent autonomic dysreflexia in two, transient urinary retention due to b lood clot in one, and acute urinary tract infection in one patient. Wi th a follow up of 3-7 months, all 10 patients have been aysmptomatic, with residual urine of less than 50 ml. There has been no migration or blocking of the stent. However, these stents require replacement at 1 2-18 months, but it is a short procedure as the Memokath, when cooled with saline at 4-degrees-C, becomes supersoft, enabling its easy and n ontraumatic removal. As these stents produce no permanent effect upon the lower urinary tract and their removal is quick, safe and atraumati c, we prefer the second generation nickel titanium alloy stent to tran surethral resection of bladder neck, external urethral sphincterotomy or permanent indwelling epithelialising stent, particularly in young s pinal cord injured patients who wish to retain their fertility potenti al.