Ke QS, Kuo HC. Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries.
Neurourol Urodyn 2010;
29:748-52. [PMID:
19731313 DOI:
10.1002/nau.20812]
[Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE
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).
PATIENTS AND 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.
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