External urethral sphincterotomy: long-term follow-up.
We retrospectively reviewed the charts of 37 male spinal cord injury patients who underwent sphincterotomy from 1986-1993 to evaluate the long-term results of this procedure. Patients were selected for the operation based on urodynamic criteria and all had some detrusor activity or were able to void by Valsalva's maneuver. There were 26 cervical injuries and 11 thoracic injuries. The operation was judged a failure if the following were present postoperatively: the presence of large post void residual volumes associated with urinary tract infections, autonomic dysreflexia symptoms associated with bladder overdistension or high voiding pressures, and/or progressive upper tract deterioration due to persistent vesicoureteral reflux or poor bladder emptying. Eighteen' operations were failures and 19 operations were successful. Causes for sphincterotomy failure included recurrent detrusor sphincter dyssynergy (6), detrusor hypocontractility (6), bladder neck contracture (3), stricture at the external sphincter (1), incomplete sphincterotomy (1), and unknown etiology (1). The reoperation rate was 32%. The mean follow-up time was 49 months for the failure group (range 2-81) and 26 months (range 2-54) for the successes. The longer mean follow-up period in the former group suggests that the number of failures increased with time. There was no predictor of failure among any of the following parameters: age at operation, level of injury, previous bladder neck/sphincter operations, preoperative maximum detrusor contraction pressures, or rise time to maximum pressure.


CONCLUSIONS
(1) the external urethral sphincterotomy, even in appropriately selected patients, can have a high failure rate over time, and (2) we could not identify any variables to predict an unsuccessful operation using our present selection criteria.
Yang
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Department of Urology, University of Washington, Seattle 98159, USA.
Mayo
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ME
D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013119:Spinal Cord Injuries / Q000601:surgery*; D016896:Treatment Outcome; D001743:Urinary Bladder; D014551:Urinary Tract / Q000601:surgery*; D014563:Urodynamics