Outcome of Dual Flange Metallic Urethral Stents in the Treatment of Neuropathic Bladder Dysfunction after Spinal Cord Injury

Purpose: To review the results of metallic urethral stents used in patients with neuropathic bladder dysfunction after spinal cord injury (SCI).Patients and Methods: In a rehabilitation unit for SCI and stroke in Cape Town, South Africa, we performed a case note review of dual flange Memokath stents placed from March 2008 until October 2011. Stents were placed rather than performing an external sphincterotomy in selected patients. With the patient under deep general anesthesia, a thermosensitive expandable metallic stent was positioned over the internal and external urethral sphincters.Results: In total, 33 stents were placed in 28 male patients. SCI was cervical in 23 patients and thoracic in 5. Average follow-up was 18 months (range 1-40 months, median 18 months). The most common indications were repeated catheter blockage in eight patients and urinary tract infection in six. The average time from SCI to stent insertion was 79 months (range 1-468 months, median 21 months). Severe autonomic dysreflexia was present in 17 cases before stent placement and in 7 after stents were placed (P = 0.003). Stents failed in 15 patients (45%) and were removed. The most common reason for failure was stone formation. Comparing the group of patients with stents lasting >20 months (n = 11) to the group with stent removal before 20 months (n = 10), the mean time between SCI and stent placement was 31 vs 119 months (P = 0.057). Medium term results (up to 27 months) were significantly influenced by earlier stent placement (P = 0.0484). One major complication was stent migration that caused an urethrocutaneous fistula.