Seoane-Rodríguez S, Sánchez R-Losada J, Montoto-Marqués A, Salvador-de la Barrera S, Ferreiro-Velasco M E, Alvarez-Castelo L, Balsa-Mosquera B, Rodríguez-Sotillo A
Spinal Cord Injury Unit, Juan Canalejo Hospital, A Coruña, Spain.
Spinal Cord. 2007 Sep;45(9):621-6. doi: 10.1038/sj.sc.3102011. Epub 2007 Jan 9.
Retrospective study.
To assess in the long-term clinical and urodynamic results of intraurethral stents in a group of patients with spinal cord injury.
Spinal Cord Injury Unit, Juan Canalejo Hospital, A Coruña, Spain.
Forty-seven consecutive male patients were studied from 1993 to 2002. All of them suffered from hyperreflexia with detrusor-sphincter dyssynergia (DSD) owing to spinal cord injury, and were treated by means of the placement of an intraurethral stent at the external sphincter.
After surgery, significant decreases in all the parameters studied were observed. The number of patients with symptoms of urinary tract infection decreased by 25% (P<0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm(3) (P=0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P=0.039). The urodynamic study showed an average reduction of 44.36 cm H(2)O in the maximum detrusor pressure (P<0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P=0.013). The most frequent stent complication was displacement, followed by stenosis, lithiasis and intraprosthetic calcification. In all, 8.5% required the stent removal.
Intraurethral stent is a good choice for the long-term management of DSD in spinal cord-injured patients, even in those who had been previously submitted to prior sphincterotomy. It has the advantage of being a potentially reversible procedure, so patients prefer it to more invasive therapies such as sphincterotomy.
回顾性研究。
评估一组脊髓损伤患者行尿道内支架置入术的长期临床和尿动力学结果。
西班牙拉科鲁尼亚胡安·卡纳莱霍医院脊髓损伤科。
对1993年至2002年期间连续的47例男性患者进行研究。所有患者均因脊髓损伤出现反射亢进伴逼尿肌-括约肌协同失调（DSD），并通过在尿道外括约肌处放置尿道内支架进行治疗。
术后，所研究的所有参数均显著下降。有尿路感染症状的患者数量减少了25%（P<0.031）。排尿后残余尿量平均减少224.3 cm³（P=0.001）。反射异常发作从35.1%降至16.2%（P=0.039）。尿动力学研究显示最大逼尿肌压力平均降低44.36 cmH₂O（P<0.0001）。放置支架后上尿路并发症从46.8%降至23.4%（P=0.013）。最常见的支架并发症是移位，其次是狭窄、结石形成和假体钙化。总共8.5%的患者需要取出支架。
尿道内支架是脊髓损伤患者DSD长期治疗的良好选择，即使是那些先前已接受括约肌切开术的患者。它具有潜在可逆性的优点，因此患者比诸如括约肌切开术等更具侵入性的治疗方法更倾向于选择它。
