title: Long-term efficacy of repeat incisions of bladder neck/external sphincter in patients with spinal cord injury.
abstract: OBJECTIVE
  To evaluate the efficacy of repeat bladder neck incision (BNI), with or without external sphincterotomy (ES). BNI/ES has been commonly used for management of neurogenic bladder in spinal cord injury (SCI) patients.
  
  
  METHODS
  This was a retrospective review of institutional review board-approved SCI database.
  
  
  RESULTS
  A total of 97 patients underwent BNI/ES over a period of 40 years. During the period reviewed, a solitary redo BNI/ES was done in 46 patients, a second redo BNI/ES was done in 23 patients, and a third redo BNI/ES was done in 7 patients with success rates of 50%, 68.2%, and 85.7%, respectively. The most common indications for surgery failure and need for repeat surgery were elevated residual for the first repeat BNI/ES, recurrent urinary tract infections for the second, and elevated residual for the third repeat BNI/ES. All patients had a normal serum creatinine level at the end of the follow-up. Mean elapsed follow-up after the last redo BNI/ES was 119 months (range, 6-408 months) for all patients evaluated. Mean durability of successful redo BNI/ES was 109.1 months, which was significantly longer than mean durability of failed redo BNI/ES at 69.4 months (P <.05).
  
  
  CONCLUSIONS
  SCI patients undergoing BNI/ES may require repeat BNI/ES to optimize lower urinary tract management. The success rate ranges from 50% to 85.7% after 3 repeat BNI/ES procedures with acceptable long-term durability and low perioperative complication rates.
authors.affiliation: Department of Urology, University of Southern California, Los Angeles, CA; Department of Urology, Meir Medical Center, Kfar Saba, Israel. Electronic address: mvainrib@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Vainrib
authors.affiliation: Urology Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA; Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Polina
authors.initials: P
authors.lastname: Reyblat
authors.affiliation: Department of Urology, University of Southern California, Los Angeles, CA; Urology Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult