View Full Version : New stent eliminates cathing for men
I have just finished reading about this new device called a UroLumex Endoprosthesis Device. We all know how cathing can be a pain and a problem. This thing is a stent which eliminates the need for cathing. That is the upside, however. The downside is you will have to wear a condom catheter. The difference between this device and a sphincterotomy is you can have the UroLumex taken out where a sphincterotomy is irreversible.
Has anyone been introduced to this device? Anyone have one?
"And so it begins."
09-14-2001, 05:56 PM
I moved this from the Cure Forum since this is a more appropriate location.
Obviously I don't have one, but I have cared for a number of patients who have had them inserted. Our center was one of the original 6 centers to do the FDA stage 3 trials in the USA.
The Urolume has been used in Europe for over 10 years, and in this country is approved for use for prostatic hypertrophy as well as treatment of DSD (detrusor-sphincter dysynergia).
It can be an alternative to traditional sphincterotomy. It is a wire mesh tube that is placed inside the urethra to hold the sphincter open. It is placed with a cystoscope in about 20 minute procedure. There is rarely any bleeding.
The stent is just laid in place (no sewing, etc.) so the biggest complication is displacement. You must do transfers with a method that does not leave the pelvis unsupported (such as slide board) and avoid anything that stretches the trunk. Dig stim must be VERY gentle. No urethral catheter can be passed for at least 6 months while it grows in place. This can be a problem if you have AD or need catheterization for another condition at all. It can still shift position, and we have had to place multiple ones in some patients. We have had two cases of overgrowth of the tissue growing through the mesh, requiring surgical removal. The device can be removed, but after it grows in place this requires a tedious procedure where each wire must be individually pulled out with a cystoscope and can take 2-3 hours to complete.
While most people drain well, sometimes it can be positional. Of course just as with a regular sphincterotomy you must wear an external catheter at all times, so this cannot be used by females or men who cannot keep an external on. If you do not drain well, and cannot crede sufficiently you may need to have it removed and a traditional sphincterotomy done or use an indwelling.
It has no risk of causing impotence which can occur with traditional cutting sphincterotomies.
It is certainly not any type of cure-all...we are still doing traditional sphincterotomies (although with a laser now), probably more so than the Urolume. (KLD)
TD- I had the stent put in this past May. The past year I've been having trouble with my bladder draining while in my chair. In bed it drains fine. The stent did not help. I still go through a lot of AD just to get some drainage. I'm currently going through my second uti in 4 weeks since the stent. There is just too much residual in me causing infections. I'm very frustrated with the stent outcome. I'm unable to cath. I've always been a condom cath user. I may have to go to a folley. It's ashame because I drain so well while lying in bed.
You mentioned drainage could be positional. I have noticed lately that if I have someone pull a hip over a bit or pull legs to slide me out a bit, my bladder will usually start draining. I've been sci for 28 years with 27 of them draining well without having to reposition. It seems something inside of me has changed causing blockage until I have some sort of repositioning. Any tips or advice you might have regarding my situation???
This is simplistic, but our urologist explains this that some men with SCI have a "flex-straw" and others have a "straight straw" urethra. The "straight straw" men do not drain well when sitting as it kinks off their urethra. We have also found this more commen in men who have been injured for some time, so perhaps it is related to changes in the pelvic floor musculature.
Anyway, we have been successful in either using custom wheelchair cushions that are designed with perineal cut-outs (less perineal pressure), and with using power chairs that have recline (not just tilt in space) features. We find that most men with this problem can trigger their bladder to empty doing a recline or a special cushion. I hope this helps.
Interesting, thanks for enlightening me! Guess I must have a kinking straight straw. Makes sence. When I'm in my shower chair, which has a commode seat, I drain easily. The pressure triggers the problem. Gonna tie down some center pods on my Roho cushion and try that for awhile.
You mentioned some problems which I would like to address. I always use a slide board so from what you said I should not have a problem. Will this eventually go away? Will I have to give up lying on my stomach to stretch the trunk muscles? How long? I also do pressure release lifts, will I have to stop? If so, for how long?
Do you know if this is a recommended alternative to cathing?
"And so it begins."
09-18-2001, 03:28 PM
TD, ever try doing pressure-relief lifts when voiding? This has a similar effect for me as lying down. Sometimes, voiding is easier when lifting up even just for a second to get things started. Also, if I lightly tap on my lower-abdomen over tje bladder, this causes to bladder to contract and the bladder sphincter to relax. I can feel when I gotta go but can't conciously make myself pee. http://sci.rutgers.edu/forum/images/smilies/rolleyes.gif
"Because you're not promised tomorrow." ~ Stuck Mojo
09-18-2001, 06:09 PM
TD, the precautions about supporting the pelvis and not doing things like pushups that stretch the pelvis are kept in place only for the first 3-6 months until the stent has firmly grown in place. We teach tilt in space, side to side or lean-forward weight shifts instead of push-ups during that time.
I am not sure what you mean by "an alternative to cathing". Generally you will have less UTIs doing CIC than using an external, which is required continuously with either a stent or sphincterotomy. (KLD)