Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries.
OBJECTIVE
Detrusor-sphincter dyssynergia (DSD) and bladder neck dysfunction (BND) may cause voiding dysfunction in patients with spinal cord injury (SCI). We report the surgical outcomes in patients with high-level SCI who underwent transurethral incision of the bladder neck (TUI-BN).


METHODS
Twenty-two patients with SCI at or above the mid-thoracic level who presented with voiding dysfunction due to BND with different types of DSD received TUI-BN. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentations. Satisfactory outcome was defined as having improvement of AUA/IPSS quality-of-life (QoL) index by >or=2.


RESULTS
Among the patients, 19 (86.4%) were men and 3 (13.6%) were women. Thirteen patients had cervical and nine had thoracic SCI. Postoperatively, spontaneous voiding by abdominal triggering with an open urethral sphincter was noted in 19 patients (86%) and AD had resolved in 15 patients (88.2%). Detrusor pressure decreased significantly in 9 patients who had a high voiding pressure at baseline, and increased significantly in 13 patients who showed impaired detrusor contractility preoperatively. Eighteen patients (82%) reported satisfactory outcome, increased maximum flow rate (Q(max)), decrease in postvoid residual (PVR) postoperatively. In addition, 82% of the patients were catheter free or reported a decrease in the frequency of clean intermittent catheterization after TUI-BN.


CONCLUSIONS
TUI-BN is effective in restoring spontaneous voiding, increasing Q(max), and decreasing PVR in high-level SCI patients. TUI-BN also leads to improvement in reducing bladder outlet resistance, reduction in occurrence of AD episodes, and improvement in QoL.
Ke
Qian-Sheng
QS
Department of Urology, Lo-Tung Po-Ai General Hospital, Lo-Tung, Yilan, Taiwan.
Kuo
Hann-Chorng
HC
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications*; D014521:Urethra; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult