EXTERNAL URETHRAL SPHINCTEROTOMY - LONG-TERM FOLLOW-UP

We retrospectively reviewed the charts of 37 male spinal cord injury p atients who underwent sphincterotomy from 1986-1993 to evaluate the lo ng-term results of this procedure. Patients were selected for the oper ation based on urodynamic criteria and all had some detrusor activity or were able to void by Valsalva's maneuver. There were 26 cervical in juries and 11 thoracic injuries. The operation was judged a failure if the following were present postoperatively: the presence of large pos t void residual volumes associated with urinary tract infections, auto nomic dysreflexia symptoms associated with bladder overdistension or h igh voiding pressures, and/or progressive upper tract deterioration du e to persistent vesicoureteral reflux or poor bladder emptying. Eighte en operations were failures and 19 operations were successful. Causes for sphincterotomy failure included recurrent detrusor sphincter dyssy nergy (6), detrusor hypocontractility (6), bladder neck contracture (3 ), stricture at the external sphincter (1), incomplete sphincterotomy (1), and unknown etiology (1). The reoperation rate was 32%. The mean follow-up time was 49 months for the failure group (range 2-81) and 26 months (range 2-54) for the successes. The longer mean follow-up peri od in the former group suggests that the number of failures increased with time. There was no predictor of failure among any of the followin g parameters: age at operation, level of injury, previous bladder neck /sphincter operations, preoperative maximum detrusor contraction press ures, or rise time to maximum pressure. In conclusion: (1) the externa l urethral sphincterotomy, even in appropriately selected patients, ca n have a high failure rate over time, and (2) we could not identify an y variables to predict an unsuccessful operation using our present sel ection criteria. (C) Wiley-Liss, Inc.