Management of sphincter dyssynergia using the sphincter stent prosthesis in chronically catheterized SCI men.
Management of sphincter dyssynergia using the sphincter stent prosthesis in chronically catheterized SCI men.
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使用括约肌支架假体治疗长期插管 SCI 男性的括约肌协同失调。
DOI：
10.1080/10790268.1995.11719384
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Foote,JE
中科院分区：
文献类型：
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作者：
Chancellor,MB;Rivas,DA;Abdill,CK;StaasJr,WE;Bennett,CJ;Finocchiaro,MV;Razi,S;Bennett,JK;Green,BG;Foote,JE
这项工作代表了UroLume括约肌支架假体的长期多中心北美试验的子集分析，以确定括约肌支架假体在患有逼尿肌-外括约肌协同失调（DESD）并长期使用留置导尿管治疗的SCI男性中的作用。在这项研究中，153名男性患者中的41名在放置括约肌支架假体前后进行了尿动力学评价。在41名患者中，34名（81%）患有颈部损伤，而10名患者（25%）以前曾接受过外括约肌切开术治疗。40名患者（98%）患有复发性尿路感染（UTI），平均每年发生4.6±3次UTI。七位病患（17%）在置放支架前就表现出肾积水，追踪时间从六至四十四个月不等。排尿压从术前的平均77±23 cmH 20降至支架插入后12个月（n=34）的35±18 cmH 20和24个月（n=22）的33±20 cmH 20（p=0.001）。排尿后残余尿量从插入前的202±187 ml降至插入后24个月的64±69 ml（p=0.001）。最大膀胱测压容量保持恒定，插入前为201 ±144 ml，插入后24个月为203±79 ml（p=0.75）。随访24个月后，10例患者（n =31）和31例未行外括约肌切开术的患者（n =10）的任何尿动力学参数均无显著变化，任何患者均未发生需要输血的出血、梗阻性增生性上皮过度生长、支架结壳或结石形成，也未发生软组织侵蚀。未观察到对勃起功能的有害影响。7例术前肾积水患者中，4例肾积水消退，3例肾积水改善。82%的患者在六个月后表现出完全的支架上皮化，而96%的患者在支架插入两年后上皮化。在3例患者中，支架移位需要在第一个月内重新定位或取出。在另外两名患者中，支架假体在插入后一年因避孕套导管引流问题而被移除，括约肌支架假体是一种有吸引力的、潜在可逆的治疗选择，即使之前已经进行了外括约肌切开术，但对于使用留置导管管理的DESD男性患者来说。（J Spinal Cord Med;]8：88-94）
This effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6±3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement.Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77±23 cmH20 preoperatively to 35±18 cmH20 at 12 months (n=34) and 33±20 cmH2Û at 24 months (n=22) after stent insertion (p=0.001). Post-void residual urinary volume decreased from 202±187 ml preinsertion to 64±69 ml at 24 months (p=0.001) postinsertion. Maximum cystometric capacity remained constant at 201 ±144 ml preinsertion to 203±79 ml at 24 months (p=0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n=10) and without (n=31) previous external sphincterotomy.Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient. No deleterious effects were observed on erectile function. Hydronephrosis resolved in four, and improved in three, of seven patients with hydronephrosis preoperatively. Eighty-two percent of the patients demonstrated complete stent epithelialization after six months, while 96 percent were epithelialized two years after stent insertion. In three patients, stent migration required repositioning or removal within the first month. In another two patients, the stent prostheses were removed one year postinsertion because of problems with condom catheter drainage.The sphincter stent prosthesis is an attractive, potentially reversible treatment option for DESD in men managed with an indwelling catheter, even if external sphincterotomy has been performed previously.(J Spinal Cord Med;]8:88–94)