TRANSURETHRAL SPHINCTEROTOMY IN QUADRIPLEGIC PATIENTS - LONG-TERM-FOLLOW-UP

Sphincterotomy was the treatment of choice in spinal cord injured pati ents with reflex bladder activity and detrusor sphincter dyssynergia a fter World War II. However, nowadays the conversion of a spastic bladd er into a low pressure reservoir by medication or operatively has beco me a more favourable bladder management. Only in quadriplegic patients who are not able to perform self-catheterization, this treatment moda lity seemed to be an alternative. With twelve o'clock sphincterotomy, urodynamic parameters of the lower urinary tract can be brought to fav ourable measures (leak-point, residuals). However, the reoperation rat e for the maintenance of these urodynamic results is high (57%). Laser sphincterotomy seems to be advantageous in this respect, as it reduce s the need for resphincterotomy significantly. Additionally, 14% of th e patients needed operations, which made condom fixation possible. Upp er tract could only be preserved if sphincterotomy is done early enoug h. Patients who do not empty completely while in the wheelchair are at risk to develop a hydronephrosis. (C) 1995 Wiley-Liss, Inc.