AbstractThis 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 cmH2Ûat 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)