OUTCOME OF ENDOSCOPIC BLADDER TRANSECTION

Objective To determine the clinical, symptomatic and objective urodyna mic outcome of patients undergoing endoscopic bladder transection. Pat ients and methods The study included 20 men and 30 women (mean age of 50+/-15 years, range 20-86) who underwent endoscopic bladder transecti on. Their underlying diagnoses were idiopathic detrusor instability (4 1), enuresis with instability (6), multiple sclerosis (2) and Parkinso n's disease (1). A full-thickness endoscopic transection of the bladde r was performed under general anaesthesia. Subjective assessment was p erformed using symptom scores (0-14 points) and a Visick grading syste m (group A-E). Objective assessment was carried out using urodynamic s tudies. The mean follow-up period was 6 years (57+/-22 months, range 6 -85). Results The mean hospital stay was 8+/-3 days (range 3-22). No p atients died after the operation. Postoperative complications included extra-peritoneal extravasation (2), recurrent urinary tract infection (5) and urethral stricture (1), Symptom scores before and after the o peration were 9+/-2 (range 4-14) and 8+/-3 (range 1-14) points respect ively. The overall outcome of the procedure was satisfactory in only e ight (16%) patients. The mean duration of symptomatic relief was 17 we eks (range 3-53), There was no significant difference between urodynam ic results before and after the operation, Bladder instability observe d in all patients before operating was demonstrated in 93% of patients after the operation. Conclusion The results of our study suggests tha t endoscopic bladder transection produces only a transient symptomatic relief in a few of those patients who have failed to respond to pharm acological manipulations. We do not feel that its continued role is ju stified.