Chartier-Kastler E J, Thomas L, Bussel B, Chancellor M B, Richard F, Denys P
Department of Urology, Pitié-Salpêtrière Hospital, University Pierre et Marie Curie (Paris VI), 83, boulevard de l'Hôpital, F-75013 Paris, France.
Eur Urol. 2001 Mar;39(3):326-31. doi: 10.1159/000052462.
To assess the feasibility of a temporary urethral stent through the striated sphincter in patients in the early phase (before 6 months) of spinal cord injury (SCI) in a department of neurological rehabilitation.
Fourteen consecutive men with SCI with urinary retention within 6 months after SCI were prospectively treated. Thirteen patients were tetraplegic (C2 to C7) and 1 was paraplegic. All patients were managed with indwelling catheters (10) or intermittent catheterization (4). The Nissenkorn polyurethane urethral stent was inserted across the external sphincter under local anesthesia for an anticipated 4-month duration.
No perioperative complications were encountered. Hospital mean stay at the urological department was 1.9 days (range 1-4 days). All patients had good emptying of the bladder (residual urine less than 100 ml) and were free of all types of catheterization. Five stents had to be repositioned in the first 2 weeks, 1 was removed for obstruction at 2.5 months. There was no lithiasis, no upper urinary tract alteration, no symptomatic infection nor local discomfort during follow-up. At a mean of 3.7 months after implantation, 10/14 (71.5%) patients chose sphincterotomy by permanent urethral stent and 4 had stent removal for learning of self-intermittent catheterization (3) and indwelling catheter (1).
The temporary sphincter stent is a new, feasible and reversible technique to manage neuropathic bladder dysfunction in the early phase after SCI. A randomized study on intermittent catheterization should be conducted. It should consider patients' and nursing caregivers' evaluations.
评估在神经康复科对脊髓损伤（SCI）早期（6个月内）患者经横纹括约肌置入临时性尿道支架的可行性。
前瞻性治疗14例SCI后6个月内出现尿潴留的男性患者。其中13例为四肢瘫（C2至C7），1例为截瘫。所有患者均采用留置导尿管（10例）或间歇性导尿（4例）处理。在局部麻醉下将尼森科恩聚氨酯尿道支架经外括约肌置入，预期留置4个月。
未发生围手术期并发症。泌尿外科平均住院时间为1.9天（范围1 - 4天）。所有患者膀胱排空良好（残余尿量少于100 ml），且无需任何类型的导尿。5个支架在最初2周内需要重新定位，1个支架在2.5个月时因梗阻被取出。随访期间未出现结石、上尿路改变、有症状的感染或局部不适。植入后平均3.7个月时，14例患者中有10例（71.5%）选择通过永久性尿道支架行括约肌切开术，4例因学会自行间歇性导尿（3例）和留置导尿管（1例）而取出支架。
临时性括约肌支架是一种治疗SCI后早期神经源性膀胱功能障碍的新的、可行且可逆的技术。应进行关于间歇性导尿的随机研究。该研究应考虑患者及护理人员的评估。
