Reversible Clinical Outcome After Sphincter Stent Removal

Purpose

We determined whether the self-expanding sphincter stent, a potential alternative to conventional external sphincterotomy for the treatment of detrusor external sphincter dyssynergia, causes a permanent effect on the lower urinary tract.

Materials and Methods

Four spinal cord injured men with voiding symptoms of detrusor external sphincter 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 insertion in all 4 cases due to stent migration (3) and difficulty with condom catheter urinary drainage (1).

Results

All stents were removed completely without damage to the urethra. Mean voiding pressure decreased from 62.5 plus/minus 39.4 to 20.7 plus/minus 6.5 cm. water after sphincter stent placement. One year after stent explanation mean voiding pressure remained unchanged from preoperative values of 58.5 plus/minus 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 urinary sphincter stent is an effective, reversible treatment for patients with detrusor external sphincter dyssynergia.