[Striated sphincter of the urethra. 4: Therapeutic possibilities]

Treatment of non-neurologic dyssynergia is aimed at diminishing urethral sensory impulses or the motor component of the dysreflexia. Although formal proof of efficacy is lacking, urethral dilatation or meatoplasty in young girls is still used when an obstacle exists to passage of a balloon catheter. Functional obstruction is treated by Valium for its muscle-relaxant properties, alpha-blocking agents or biofeedback. In recent neurologic dyssynergia good results have been obtained after infiltrations of the para-urethral sphincter by an endo-urethral approach. Sphincterotomy is the treatment of choice when fibrosis has developed, particularly when the upper urinary tract is being affected: it can be performed earlier in cases where the dyssynergia fails to respond to well adapted conservative therapy. The site of section should be at 12 o'clock for anatomophysiologic reasons and to reduce the risk of impotence. The only treatment for rhabdosphincter deficiency is physiotherapy: reeducation and electric stimulation. Correctly instituted reeducation involves several phases: beginning with consciousness and learning of sphincter function it terminates in the automatic activation of the sphincter as for example during certain efforts. Results of several documented series in the urologic literature are encouraging.