CONTACT NEODYMIUM - YTTRIUM-ALUMINUM-GARNET LASER-ABLATION OF THE EXTERNAL SPHINCTER IN SPINAL-CORD INJURED MEN WITH DETRUSOR SPHINCTER DYSSYNERGIA

Objectives. The purpose of this study was to determine the efficacy an d safety of contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser e xternal sphincterotomy as an alternative treatment of detrusor-externa l sphincter dyssynergia (DESD). Methods. Twenty-two spinal cord injure d men with video-urodynamically verified DESD underwent external urina ry sphincter ablation using the contact Nd:YAG laser. Three patients w ith bladder neck obstruction required concurrent contact laser bladder neck incision. Preoperative urodynamic parameters of voiding pressure , bladder capacity, and residual urine were compared with those obtain ed 1 year postoperatively. Results. Each procedure was performed with the Nd:YAG contact laser set at 40 to 50 W, with a total accumulated e nergy of 23,800 to 60,000 J for each patient. The mean duration of sur gery was 45 +/- 21 minutes. Bladder voiding pressure decreased from 87 +/- 23 preoperatively to 47 +/- 11 cm H2O at 12 months (P <0.01). Res idual urine volume decreased significantly, from 122 +/- 77 to 33 +/- 19 mL at 12 months (P <0.01), and bladder capacity remained unchanged at 174 +/- 84 and 230 +/- 92 mL (P = 0.57). Three patients were found to have recurrent sphincter obstruction 1 year after laser sphincterot omy. Two patients experienced complications associated with condom cat heter urinary drainage and returned to the use of an indwelling cathet er. One patient experienced diminished reflex erectile function postop eratively. No patient required blood transfusion. No deleterious effec ts on renal function or symptoms of autonomic dysreflexia were noted. Conclusions. External urinary sphincter ablation using the contact Nd: YAG laser compares favorably with electrosurgical techniques.