Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries

• Published in: Neurourology and urodynamics 2010-06, Vol.29 (5), p.748-752
• Main Authors: Ke, Qian-Sheng, Kuo, Hann-Chorng
• Format: Article
• Language: English
• Subjects: Adult; Aged; bladder neck dysfunction; detrusor-sphincter dyssynergia; Female; Humans; Male; Middle Aged; Spinal Cord Injuries - complications; spinal cord injury; transurethral incision; Urethra; Urinary Bladder - surgery; Urinary Bladder Diseases - etiology; Urinary Bladder Diseases - surgery; Urination Disorders - etiology; Urination Disorders - surgery; Urologic Surgical Procedures - methods; Young Adult
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.20812

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 ≥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 (Qmax), 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 Qmax, 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. Neurourol. Urodynam. 29:748–752, 2010. © 2010 Wiley‐Liss, Inc.