[External sphincterotomy using bipolar vaporisation in saline. First results]

[Surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia]

PURPOSE

To evaluate middle term results of surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia.

PATIENTS AND METHOD

Retrospective study about 44 patients whom underwent urinary sphincterotomy between January 2008 and September 2012. All patients had detrusor-sphincter dyssynergia. Mean age was 49.7 years. Seventy percent (n=30) of patients had spinal cord injury, 80% (n=34) underwent urethral stent. Sphincterotomy was performed in 55% (n=24) with monopolar resection and in 43% (n=19) with Revolix(®) laser, after urethral stent withdrawal.

RESULTS

Mean follow-up was 30 months. Mean hospitalization stay was 5 days. Mean preoperative post-voiding residue (PVR) was 149mL and postoperative was 176mL. Twenty-nine percent (n=13) underwent new sphincterotomy with a final mean 116mL PVR, and a mean delay before new sphincterotomy of 9 months. Twenty percent (n=9) underwent other surgical procedure for sphincterotomy fail.

CONCLUSION

In this series, we observed that surgical sphincterotomy is a well tolerated procedure, but with moderate immediate efficiency about 57%. It requires sometimes second procedure and long term follow-up in order not to fail to recognize stenosis, with best surgical success (80%).

[Treatment of detrusor-striated sphincter dyssynergia with permanent nitinol urethral stent: results after a minimum follow-up of 2 years]

OBJECTIVES

The aim of this study was to assess the outcomes of nitinol permanent urethral stents used in detrusor-striated sphincter dyssynergia (DSD) treatment on male patients with a spinal cord injury.

MATERIALS

We investigated retrospectively all patients treated from 2004 to 2012. A total of 22 patients were included, with an age ranging from 22 to 76 years old. The DSD syndrome was due to spinal cord injury (18) or various spinal cord diseases (four) and treated with a nitinol urethral stent (11 Ultraflex(®) and 11 Mémotherm(®)). Every patient had an urodynamical study. The follow-up reached at least 2 years.

RESULTS

The mean follow-up was 56 months (± 14). Complementary procedures after stenting included: five stent prolongation or displacement (mean interval 7.6 months), six bladder neck incisions (12.2 months), three urethrotomy (42 months), ten obstruction treated by laser (47.3 months). Eight patients had a change of their urinary pattern: four underwent ileal conduit diversion, one had a continent urinary diversion, one chose self intermittent catheterization, two were under indwelling catheterization waiting for another treatment. Stent retrieval was either harmful or impossible for four of them. Three patients were free of complementary procedures.

CONCLUSIONS

Nitinol urethral stent was an effective treatment initially. However, by the third year, urethral stenosis and hypertrophic growth of the urethral mucosa usually require iterative endoscopic procedures (0.31 per patient per year). Patients treated with permanent uretral stent deserve a yearly endoscopic follow-up. Safety and effectiveness of permanent uretral stent compared to surgical sphincterotomy to treat DSD are discussed.