A urethral stent for the treatment of detrusor-striated sphincter dyssynergia

Objective To assess the technique, efficacy and complications of the Ultraf lex(R) urethral stent (Boston Scientific Corp., Boston, MA) for the treatme nt of detrusorstriated sphincter dyssynergia (DSD). Patients and methods Forty consecutive patients with DSD who had a Ultrafle x(R) stent placed in the membranous urethra were evaluated prospectively, D SD was caused by spinal cord injury in 30, multiple sclerosis in six and ot her neurological diseases in four. All patients were either tetraplegic or paraplegic and unable to use intermittent self-catheterization. Previous bl adder management consisted of an indwelling catheter in 15 patients, chroni c suprapubic catheters in two, intermittent catheterization in nine. and tr igger reflex micturition in 14. The Ultraflex stent was placed under local anaesthesia. The stents were 50 mm long in 36 patients, 45 mm in two and 40 mm in two. The mean (SD) follow-up was 16.9 (13.8) months. Results The mean (SD) residual urine decreased from 245.9 (117) mL before s tenting to 65.2 (19.3) mL at 12 months afterward (n = 19). One stent was re moved at 13 months for chronic prostatic and urinary tract infection leadin g to autonomic dysreflexia. There was no stent stenosis and 17 of 18 stents had >75% epithelial coverage at one pear. None of the stents migrated. Sev en patients underwent secondary bladder neck incision through the stent. Th e stent length was increased in four patients using a second overlapping di stal stent, twice during the first procedure and twice within 6 months beca use the sphincter was inadequately covered. Conclusions The Ultraflex(R) stent achieved the expected results for a pros thetic sphincterotomy and appears to be an appropriate but less invasive tr eatment for DSD.