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                        JeffNEWS, August 16, 1994
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Urologists to Test Ability of Wire Mesh Stent 
to Keep Bladder Sphincter Open
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Jefferson is one of three sites sharing a three-year, $360,000 grant 
from the National Center for Medical Rehabilitation Research of the 
National Institutes of Health for a study comparing two different 
techniques, one old and one new, to treat detrusor sphincter dyssynergia 
among men.

In patients with this condition, which occurs frequently in those with 
spinal-cord injuries - 87 percent of whom are men - or who have diseases 
such as multiple sclerosis, the sphincter muscle at the neck of the bladder 
has lost its automatic ability to relax when the patient is ready to 
urinate. This means that the sphincter remains closed even when the full 
bladder is ready to empty its urine.	

The older technique, external sphincterotomy, involves making a surgical 
incision in the sphincter. Then, patients must use an indwelling catheter 
that passes up through the newly created opening in the sphincter and goes 
directly into the bladder.

The new technique opens the sphincter muscle by nonsurgically inserting 
a prosthesis - a tiny, cylindrical wire mesh stent - into the circular 
muscle. The sphincter is now permanently open and urine in the bladder can 
flow past it. This makes it possible for patients to wear an external 
catheter consisting of a rubber sheath connected to plastic tubing that 
conducts the urine into a plastic bag.

"The new technique seems to have many benefits," said principal 
investigator, Michael B. Chancellor, MD, assistant professor of urology. 
"It appears to reduce complications such as bleeding and impotence. It may 
also help avoid life-threatening kidney failure, potentially fatal urinary 
tract infections and multiple operations, which will, in turn, reduce 
healthcare costs. 

In addition, the stent may allow patients to enjoy an improved quality 
of life.

"Having the new technique at our disposal places Jefferson in the 
forefront of those investigating new rehabilitative treatments in the field 
of urology," Dr. Chancellor said.

Other Jeffersonians involved in this research are Jacqueline R. Carter, 
study coordinator, department of urology, and Bruce S. Olsen, statistician, 
department of pharmacology.

The two other institutions participating in the grant are the Rancho Los 
Amigos Medical Center in Rancho Los Amigos, California, and Shepherd Spinal 
Cord Injury Center in Atlanta, Georgia, which is affiliated with Emory 
University.


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