title: Prospective comparison of external sphincter prosthesis placement and external sphincterotomy in men with spinal cord injury.
abstract: The effectiveness and complications of the treatment of detrusor-external sphincter dyssynergia (DESD) and voiding pressure > 60 mm H2O using an endoluminal urethral sphincter prosthesis (Urolume) were compared with those of conventional external sphincterotomy in 46 men with spinal cord injury (SCI) (mean age 34 years; range 18-58 years). Twenty-six patients elected the Urolume, and 20 chose sphincterotomy. The age and level and duration of SCI were similar in the two groups. Follow-up ranged from 6 to 20 months. After prosthesis placement, voiding pressure dropped from 88 +/- 29 cm H2O to 38 +/- 22 cm H2O at 6 months (n = 23) and 35 +/- 16 cm H2O at 12 months (n = 18) (P < 0.001). The residual urine volume fell from 180 +/- 145 mL preoperatively to 85 +/- 125 mL at 12 months (P < 0.001), while the maximum cystometric capacity remained constant (P = 0.75). External sphincterotomy achieved similar statistically significant decreases in voiding pressure and residual urine volume, and bladder capacity was maintained. The preoperative and follow-up urodynamic measures were similar in the two groups. Prosthesis placement was associated with a significantly shorter operation (P = 0.001) and length of hospitalization (P = 0.01), a lower hospitalization cost (P = 0.01), and less bleeding (change in hemoglobin concentration) (P = 0.01) than external sphincterotomy. The complications of stent insertion were device migration (n = 4) and secondary bladder neck obstruction (n = 2). One patient with continuing reflux required bilateral ureteral implantation. The complications of sphincterotomy were bleeding necessitating transfusion (n = 2), recurrent obstruction (n = 2), and erectile dysfunction (n = 1). The sphincter prosthesis is as effective as sphincterotomy in the treatment of DESD, while being technically easier, less morbid, and less expensive.
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: D A
authors.initials: DA
authors.lastname: Rivas
authors.forename: M B
authors.initials: MB
authors.lastname: Chancellor
authors.forename: D
authors.initials: D
authors.lastname: Bagley
mesh_terms: D000328:Adult; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D010410:Penile Erection; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D011859:Radiography; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000601:surgery*; D015607:Stents; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D016741:Urinary Sphincter, Artificial