Transurethral placement of external sphincter wire mesh stent for neurogenic bladder

Abstract

Literature reports experience using a transurethral prosthetic stent for the treatment of neurogenic bladder in males with spinal cord injury who also have detrusor-external sphincter dyssynergia (DESD). The Urolume prosthesis, a cylindrical wire mesh stent, was inserted in the membranous urethra of 25 spinal cord injured males with DESD and elevated voiding pressure. Patient education regarding care of external condom urine collecting devices was an important preoperative requirement ensuring long-term success. One-year post-stent placement subjects showed a statistically significant decrease in voiding pressure and residual urine volume. Bladder capacity remained constant. All subjects were able to achieve spontaneous reflexive voiding without constant dribbling. There were no complications of bladder stone formation, tissue overgrowth within the stent, untoward effects on renal or erectile function, or pain. Patients reported decreased autonomic dysreflexia symptoms and significant psychosocial benefits such as decreased incontinence and freedom from indwelling catheters. Patient satisfaction, ease of placement, and minimal associated morbidity make sphincter stent placement an effective alternative to external sphincterotomy.