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Related Experiment Videos

Sphincterotomy failure in neurogenic bladder disease.

J L Lockhart, B Vorstman, D Weinstein

    The Journal of Urology
    |January 1, 1986
    PubMed
    Summary

    External urethral sphincterotomy can improve bladder function in spinal cord injury patients, but failure, often due to poor detrusor contractility, necessitates further investigation into underlying causes like detrusor-sphincter dyssynergia.

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    Area of Science:

    • Urology
    • Neurosurgery
    • Rehabilitation Medicine

    Background:

    • Spinal cord injury (SCI) frequently leads to lower urinary tract dysfunction.
    • External urethral sphincterotomy is a surgical option to manage detrusor-sphincter dyssynergia and improve bladder emptying in SCI patients.
    • Understanding failure patterns is crucial for optimizing treatment outcomes.

    Purpose of the Study:

    • To evaluate the success and failure rates of external urethral sphincterotomy in spinal cord injury patients.
    • To identify urodynamic findings associated with treatment failure.

    Main Methods:

    • A retrospective analysis of 60 spinal cord injury patients who underwent external urethral sphincterotomy.
    • Success defined by resolution of symptomatic urinary tract infections and low vesical residuals.

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  • Urodynamic studies were performed to assess bladder function in patients experiencing treatment failure.

    • Main Results:

    • 45 out of 60 patients (75%) experienced successful outcomes.
    • 15 patients (25%) failed to achieve success, characterized by persistent infections and high bladder residuals.
    • Urodynamic findings in failures included detrusor areflexia (66%), detrusor-sphincter dyssynergia (13.2%), and bladder neck obstruction (13.2%), with poor detrusor contractility being predominant.

    Conclusions:

    • External urethral sphincterotomy is effective in a majority of spinal cord injury patients with lower urinary tract dysfunction.
    • Poor detrusor contractility is a common finding among treatment failures.
    • Detrusor-sphincter dyssynergia and bladder neck obstruction may indicate the need for complementary surgical interventions, such as bladder neck incision.