[External sphincterotomy using bipolar vaporisation in saline. First results].
OBJECTIVE
The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia.


METHODS
Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year.


RESULTS
At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average.


CONCLUSIONS
External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture.
Service d'urologie, transplantation rénale et andrologie, CHU de Rangueil, TSA 50032, 31059 Toulouse, France.
L
L
Even
J
J
Guillotreau
N
N
Mingat
E
E
Castel-Lacanal
E
E
Braley
B
B
Malavaud
P
P
Marque
P
P
Rischmann
X
X
Gamé
D004598:Electrosurgery / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D014525:Urethral Stricture / Q000209:etiology; D016055:Urinary Retention / Q000628:therapy*; D014835:Volatilization
D012965:Sodium Chloride