Use of the Memokath for detrusor-sphincter dyssynergia after spinal cord injury--a cautionary tale.

We report on the intraurethral insertion of the Memokath in 24 patients (26 stents) to combat detrusor-sphincter dyssynergia developing after spinal cord injury. Most patients have high tetraplegia for whom self-catheterisation is very difficult, if not impossible. Our results have been disappointing in that 19 stents have had to be removed, mainly because of persisting urinary infection, migration of the stent, or because of failure to improve emptying, usually associated with poor detrusor function. Caution is therefore advised in the use of this stent for detrusor-sphincter dyssynergia and it is not recommended in patients with chronic urinary infection. With better patient selection however, perhaps aided by modifications to stent design, the Memokath may still prove to be a simple and reversible alternative to sphincterotomy in this difficult group of patients.