Results 1 to 10 of 10

Thread: To get a stent or not?

  1. #1
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
    Posts
    740

    To get a stent or not?

    Anyone have experience with this?
    For the first time since my accident, I have an appointment to see a urologist.
    I don't like cathing.
    What are the negatives of having a stent put in?
    Cancer risk?
    More infections?
    If there is a breakthrough in bladder management, might it be bad that I had a stent put in?
    Any help would be appreciated (in deciding how to best take care of myself).
    Rich

  2. #2
    Hi,

    To answer your questions, I need further information.
    Are they recommending a stent due to an obstruction somewhere?

    AAD

  3. #3
    Senior Member Scorpion's Avatar
    Join Date
    Jul 2001
    Location
    Los Angeles
    Posts
    5,887
    I would think the downsides of a stint (leg bag, leaking no matter what if you want to have sex, no reversal if there's a therapy to restore bladder function, etc) outweigh the upside.

  4. #4
    Quote Originally Posted by pararich View Post
    Anyone have experience with this?
    For the first time since my accident, I have an appointment to see a urologist.
    I don't like cathing.
    What are the negatives of having a stent put in?
    Cancer risk?
    More infections?
    If there is a breakthrough in bladder management, might it be bad that I had a stent put in?
    Any help would be appreciated (in deciding how to best take care of myself).
    Rich,

    Let me summarize the benefits and risks of a stent.

    Benefits
    1. It holds open the bladder sphincter without requiring a sphincterotomy (cutting of the sphincter). It is associated with less bleeding and other complications than a sphincterotomy and tends to hold the sphincter open for longer.
    2. A conventional sphincterotomy is not reversible, closes 40% of the time.

    Risks
    1. It is not necessarily reversible. Over a long period, a stent will compromise the sphincter. It is less likely to do so than a sphincterotomy but if the stent is removed, the sphincter may be incompetent for a long period and this may be difficult to fix.
    2. If the stent is improperly placed, its complication and failure rate can be relatively high. Less than 2% of men with spastic bladders have had a stent placed, even though the Urolume stent has been available and approved by the FDA for more than a decade.
    3. Many men will need more than one stent in order to keep not only the internal and external sphincter open.

    So, if you opt to get a stent, you should be aware that it is not necessarily reversible and it must be put in by an experienced urologist who knows what he or she is doing. Note that there are new sphincterotomy procedures that have much lower complication rates, using a laser to cut the sphincter. There is a need for a double blind randomized trial to compare laser sphincterotomy and Urolume stent placement.

    To my knowledge, neither sphincterotomy nor the stent increases the risk of cancer. I attach a short recent commentary on the stent by a urology...

    Wise.

  5. #5
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
    Posts
    740
    Quote Originally Posted by SCI-Nurse View Post
    Hi,

    To answer your questions, I need further information.
    Are they recommending a stent due to an obstruction somewhere?

    AAD
    KDL,
    Dr. Formal, at Magee, only suggested Botox for my bladder.
    I have an appointment, soon, with a urologist about the botox. My peer mentor from Magee had a sphincterotomy many years ago, I think. He says it's the way to go so he doesn't have to cath. I wanted to know more about a stent or sphincterotomy.
    Dr. Young's info has helped.
    Rich

  6. #6
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
    Posts
    740
    Quote Originally Posted by Wise Young View Post
    Rich,

    Let me summarize the benefits and risks of a stent.

    Benefits
    1. It holds open the bladder sphincter without requiring a sphincterotomy (cutting of the sphincter). It is associated with less bleeding and other complications than a sphincterotomy and tends to hold the sphincter open for longer.
    2. A conventional sphincterotomy is not reversible, closes 40% of the time.

    Risks
    1. It is not necessarily reversible. Over a long period, a stent will compromise the sphincter. It is less likely to do so than a sphincterotomy but if the stent is removed, the sphincter may be incompetent for a long period and this may be difficult to fix.
    2. If the stent is improperly placed, its complication and failure rate can be relatively high. Less than 2% of men with spastic bladders have had a stent placed, even though the Urolume stent has been available and approved by the FDA for more than a decade.
    3. Many men will need more than one stent in order to keep not only the internal and external sphincter open.

    So, if you opt to get a stent, you should be aware that it is not necessarily reversible and it must be put in by an experienced urologist who knows what he or she is doing. Note that there are new sphincterotomy procedures that have much lower complication rates, using a laser to cut the sphincter. There is a need for a double blind randomized trial to compare laser sphincterotomy and Urolume stent placement.

    To my knowledge, neither sphincterotomy nor the stent increases the risk of cancer. I attach a short recent commentary on the stent by a urology...

    Wise.
    Wise, thanks.
    I'm always impressed with your understanding of some of the complexities of the body and medicine.
    Now I'm more informed and it will help when I see a urologist.
    Rich

  7. #7
    Bladder or sphincter Botox? Sphincter Botox is sometimes tried instead of a sphincterotomy or stent, but in our experience, it does not work very well, and of course must be repeated over and over. It is more technically difficult to do well, as well.

    Bladder Botox would not be used if your goal is reflex voiding, as the goal with this is to paralyze the bladder to increase capacity and decrease pressures so that safe intermittent cath can be continued.

    Keep in mind that you may still have to cath even after having a procedure to either cut, hold open, or paralyze the sphincter, as your bladder muscle itself may not be efficient enough to get your residual urine to a low enough level, and if so, this would increase your risks for UTIs unless you also cath several times daily. Long term, there is a good chance your bladder can decompensate and no longer work well at all, requiring then either intermittent cath or an indwelling catheter, both of which would be problematic if you have had your sphincter cut or a stent, as you would have great difficulty not leaking between caths or around the indwelling catheter.

    (KLD)

  8. #8
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
    Posts
    740
    Thanks again KDL,
    At my last appointment, Dr. Formal recommended Botox for my bladder.
    I think I need urodynamic testing to see what is going on with my bladder.
    For the first year, my bladder didn't leak. I cathed 4 times a day.
    Then it started leaking. I don't know whether the pressure increased, the bladder shrunk, or the sphincters changed.
    I'm still somewhat in the dark with all this.
    Your info is helping to fill in the blanks.
    I don't particularly want any procedures done.
    But, I'm concerned that my kidneys will be damaged over time.
    Rich

  9. #9
    I had to have mine removed at Thomas Jefferson in Philad. I didn't trust the MD in NY who put it in. It was touchy, as he told me it often needs to be disassembled strand by strand. Mine he first pushed up into the bladder intact, captured it with a basket, then withdrew it. A horrendous bloody mess for days. After over a year I was "lucky" in that it never healed in place, thus deep excavation was minimized. On the other hand, that's prob the reason it migrated as well.

    To this day I still feel the constant burning throbbing pain I have deep in my pelvis started after the stent and its removal and possibly that some nerve damage was done.

  10. #10
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
    Posts
    740
    Quote Originally Posted by crags View Post
    I had to have mine removed at Thomas Jefferson in Philad. I didn't trust the MD in NY who put it in. It was touchy, as he told me it often needs to be disassembled strand by strand. Mine he first pushed up into the bladder intact, captured it with a basket, then withdrew it. A horrendous bloody mess for days. After over a year I was "lucky" in that it never healed in place, thus deep excavation was minimized. On the other hand, that's prob the reason it migrated as well.

    To this day I still feel the constant burning throbbing pain I have deep in my pelvis started after the stent and its removal and possibly that some nerve damage was done.
    I think I'll continue to use catheters to drain my bladder!
    I also wear a condom cath and leg bag because my bladder doesn't hold much before the urine drains out. But, it does hold some urine so I need to cath.
    Rich

Similar Threads

  1. need help on stent issue
    By bert4255 in forum Care
    Replies: 4
    Last Post: 10-02-2009, 08:29 PM
  2. Stent problems
    By bert in forum Care
    Replies: 5
    Last Post: 07-30-2008, 06:20 PM
  3. New Stent in Place
    By TD in forum Care
    Replies: 1
    Last Post: 10-21-2003, 03:27 PM
  4. Life with a stent (For men only)
    By TD in forum Care
    Replies: 4
    Last Post: 05-06-2003, 10:51 PM
  5. Living with a stent
    By TD in forum Care
    Replies: 3
    Last Post: 12-23-2002, 08:35 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •