[Surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia]

To evaluate middle term results of surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia.

Retrospective study about 44 patients whom underwent urinary sphincterotomy between January 2008 and September 2012. All patients had detrusor-sphincter dyssynergia. Mean age was 49.7 years. Seventy percent (n=30) of patients had spinal cord injury, 80% (n=34) underwent urethral stent. Sphincterotomy was performed in 55% (n=24) with monopolar resection and in 43% (n=19) with Revolix(®) laser, after urethral stent withdrawal.

Mean follow-up was 30 months. Mean hospitalization stay was 5 days. Mean preoperative post-voiding residue (PVR) was 149mL and postoperative was 176mL. Twenty-nine percent (n=13) underwent new sphincterotomy with a final mean 116mL PVR, and a mean delay before new sphincterotomy of 9 months. Twenty percent (n=9) underwent other surgical procedure for sphincterotomy fail.

In this series, we observed that surgical sphincterotomy is a well tolerated procedure, but with moderate immediate efficiency about 57%. It requires sometimes second procedure and long term follow-up in order not to fail to recognize stenosis, with best surgical success (80%).