Modified approach to sphincterotomy in spinal cord injury patients. Indications, technique and results in 32 patients

Indications, technique and results of a modified approach to an extended sphincterotomy in spinal cord injury patients with voiding dysfunctions is presented. There were 32 patients who underwent surgery and were subjected to analysis for their dysfunctional bladder and bladder-neck problems. Overall satisfactory results were obtained in about 90 per cent patients following sphincterotomy. Early recognition of patients where intermittent catheterisation may not succeed is presented to intervene and establish an early catheter-free status in such patients. Foley indwelling catheter in ten patients, being worn from seven months to four years, where intermittent catheterisation had not succeeded elsewhere, were decatheterised following surgery. Excellent results were obtained in ten patients with vesico-urethral reflux; external sphincterotomy, therefore, seems to be the treatment of choice for complete spinal cord transection with vesico-ureteral reflux. An attempt has also been made to present physiology of micturition reflex in spinal cord injury patients.