A 10 year review of the endoscopic treatment of 125 spinal cord injured patients with vesical outlet obstruction: does bladder neck dyssynergia exist?

Abstract

The management of 125 patients with post-traumatic neuropathic bladder and vesical outlet obstruction is described and a policy of endoscopic treatment is suggested. A total of 1652 spinal cord injured patients were treated during the period of 1983-1992. About 8% had an outlet of obstruction which required endoscopic treatment. The outcome of transurethral resection of the external sphincter and/or bladder neck was retrospectively analyzed in 82 patients, and a prospective study was conducted on the other 43 patients. We have demonstrated that patients with a complete spinal cord lesion at any level, and those with a high incomplete lesion (above T-9) have benefited from external sphincterotomy combined with bladder neck resection. We emphasize that patients with a low incomplete lesion (T-9 and below) have benefited from bladder neck resection alone. Bladder neck (internal sphincter) obstruction or dyssynergia may require to be considered in the management of the neuropathic bladder.

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

“…BND and DSD refractory to a single therapeutic modality may require simultaneous evaluation and management in some patients with SCI. 5 Although lower urinary tract dysfunction is dependent on the level of SCI, we found no correlation between therapeutic outcome and level or completeness of SCI after TUI-BN.…”

“…4 In order to resume spontaneous voiding or eradicate AD, SCI patients with BND and DSD may require surgical intervention. 5 Detrusor, bladder neck, and urethral sphincter dysfunction are usually characterized as motor neuron diseases because their features correspond to damage to the spinal cord or cauda equina, which involves the somatic and parasympathetic pathways. 6 Afferent nerves of the pudendal nerve are postulated to have a potential modulatory effect on sympathetic neuronal control in various neuropathic and non-neuropathic bladder functions, but the mechanism and pathways remain unknown.…”

Phenoxybenzamine in the Management of Neuropathic Bladder Following Spinal Cord Injury

“…This was demonstrated by voiding cysto‐urethrography which showed wide bladder neck and prostatic urethra with obstruction at the level of the external sphincter, which was also proved by urethral pressure profilometry. This might explain the previous observation made by our team that patients with complete flaccid lesions and areflex bladders did not benefit from resection of the bladder neck, so that external sphincterotomy had to be performed to achieve adequate evacuation of the bladder by crede method, and satisfactory residual urine volume 18 , 19 . Some workers have demonstrated the beneficial effect of phenoxybenzamine on a proportion of areflex bladders 10 , 12 , 13 …”

The Utility of Urodynamic Studies in Neuro-Urological Patients

“…The voiding cystometry (or pressure flow study) reflects the coordination between the detrusor and urethra or pelvic floor during the voiding phase. As most types of obstruction in NLUTD are due to DSD on a non-relaxing urethra and bladder neck, UDS may identify such findings in the context of clinically unclear voiding difficulties and an initial pathological free flowmetry (FF) and post-voiding residual urine measurement (PVR) [ 21 , 22 ]. DSD is diagnosed during the voiding phase of the UDS using electromyography [ 23 ].…”