Division of the external urethral sphincter in the neuropathic bladder: a twenty years' review

It is now twenty years since the authors first performed division of the external sphincter region in the treatment of the neuropathic bladder. Although a ten year report was published in 1967, it was decided to review all the patients at the end of the twenty year period. The rationale of the operation in the upper motor neurone lesion has been confirmed by modern investigative techniques, while it appears from recent work that the success of the procedure in the lower motor neurone case is due to division of plain muscle which is subjected to excessive sympathetic stimulation. It is the authors' firm conviction that long term catheterization, whether permanent or intermittent is a confession of failure and can be avoided in the vast majority of patients. The operation has proved of permanent benefit especially with the regard to the elimination of residual urine. Further, hydronephrosis, and renal infection and failure, are also benefited in many cases. These factors are of great importance in a condition in which late morbidity and mortality has been usually due to renal causes.