PROSPECTIVE COMPARISON OF EXTERNAL SPHINCTER PROSTHESIS PLACEMENT ANDEXTERNAL SPHINCTEROTOMY IN MEN WITH SPINAL-CORD INJURY

The effectiveness and complications of the treatment of detrusor-exter nal sphincter dyssynergia (DESD) and voiding pressure >60 mm H2O using an endoluminal urethral sphincter prosthesis (Urolume(TM)) were compa red with those of conventional external sphincterotomy in 46 men with spinal cord injury (SCI) (mean age 34 years; range 18-58 years). Twent y-six patients elected the Urolume, and 20 chose sphincterotomy. The a ge and level and duration of SCI were similar in the two groups. Follo w-up ranged from 6 to 20 months. After prosthesis placement, voiding p ressure dropped from 88 +/- 29 cm H2O to 38 +/- 22 cm H2O at 6 months (n = 23) and 35 +/- 16 cm H2O at 12 months (n = 18) (P < 0.001). The r esidual urine volume fell from 180 +/- 145 mL preoperatively to 85 +/- 125 mL at 12 months (P < 0.001), while the maximum cystometric capaci ty remained constant (P = 0.75). External sphincterotomy achieved simi lar statistically significant decreases in voiding pressure and residu al urine volume, and bladder capacity was maintained. The preoperative and follow-up urodynamic measures were similar in the two groups. Pro sthesis placement was associated with a significantly shorter operatio n (P = 0.001) and length of hospitalization (P = 0.01), a lower hospit alization cost (P = 0.01), and less bleeding (change in hemoglobin con centration) (P = 0.01) than external sphincterotomy. The complications of stent insertion were device migration (n = 4) and secondary bladde r neck obstruction (n = 2). One patient with continuing reflux require d bilateral ureteral implantation. The complications of sphincterotomy were bleeding necessitating transfusion (n = 2), recurrent obstructio n (n = 2), and erectile dysfunction (n = 1). The sphincter prosthesis is as effective as sphincterotomy in the treatment of DESD, while bein g technically easier, less morbid, and less expensive.