Shah N C, Foley S J, Edhem I, Shah P J
Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
J Endourol. 1997 Dec;11(6):485-8. doi: 10.1089/end.1997.11.485.
In spinal-injured patients, detrusor-sphincter dyssynergia (DSD) can lead to high intravesical pressures, upper tract dilation, and recurrent infections. The standard treatment for DSD is sphincterotomy and, more recently, permanent sphincter stenting. Many spinal-injury patients would prefer a reversible treatment because of concern about fertility or because they are awaiting a "miracle cure." There is also concern over the theoretical long-term risk of squamous carcinoma after permanent stenting. In view of this, the Memokath, a thermosensitive temporary stent, has been undergoing trials at our center to determine which patients could benefit. Fourteen Memokath stents have been inserted in spinal-injured patients with DSD at our center, and they have been followed up for as long as 2 years. Stents were placed under cystoscopic guidance as a day case procedure. The stents were inserted either through the sphincter alone (short [4-cm] stents; 3 patients) or through the sphincter and bladder neck (long [5-7-cm] stents; 11 patients). There were no complications during surgery in either placement or removal of these stents. There was a significant (p < 0.001) reduction in the residual urine volume after stenting. Preoperative hydronephrosis and attacks of autonomic dysreflexia noted in some patients also resolved after stenting. Short stents that bridge the external urethral sphincter were ineffective in emptying the neuropathic bladder. Therefore, we advise that only long stents that lie across both the bladder neck and the external sphincter be used. Because of its easily reversible nature, the Memokath should be adopted for use in patients who are unsure about their preferred option of bladder management and those involved in a fertility program.
在脊髓损伤患者中，逼尿肌-括约肌协同失调（DSD）可导致膀胱内压升高、上尿路扩张和反复感染。DSD的标准治疗方法是括约肌切开术，以及最近采用的永久性括约肌支架置入术。许多脊髓损伤患者由于担心生育问题或正在等待“奇迹疗法”，更倾向于采用可逆性治疗方法。人们还担心永久性支架置入术后理论上存在的长期鳞状细胞癌风险。鉴于此，一种热敏性临时支架Memokath正在我们中心进行试验，以确定哪些患者可能从中受益。我们中心已为14例患有DSD的脊髓损伤患者置入了Memokath支架，并对他们进行了长达2年的随访。支架在膀胱镜引导下作为日间手术置入。支架要么单独穿过括约肌（短[4厘米]支架；3例患者），要么穿过括约肌和膀胱颈（长[5 - 7厘米]支架；11例患者）。这些支架在置入或取出过程中均未出现手术并发症。置入支架后残余尿量显著减少（p < 0.001）。一些患者术前存在的肾积水和自主神经反射异常发作在置入支架后也得到了缓解。横跨尿道外括约肌的短支架在排空神经源性膀胱方面无效。因此，我们建议仅使用横跨膀胱颈和外括约肌的长支架。由于其易于逆转的特性，对于那些不确定自己首选膀胱管理方案的患者以及参与生育计划的患者，应采用Memokath支架。
