TRANSURETHRAL BALLOON DILATION OF THE EXTERNAL URINARY SPHINCTER - EFFECTIVENESS IN SPINAL-CORD INJURED MEN WITH DETRUSOR EXTERNAL URETHRALSPHINCTER DYSSYNERGIA

The authors investigated balloon dilation as a minimally invasive alte rnative to transurethral external sphincterotomy for the treatment of detrusor-external urethral sphincter dyssynergia (DESD). Seventeen spi nal cord-injured men with voiding pressures greater than 60 cm H2O und erwent balloon dilation of the external sphincter to 90 F at 4 atm of pressure for 10 minutes. The mean voiding pressures before and 12 mont hs after dilation were 83 cm H2O +/- 35 and 37 cm H2O +/- 15, respecti vely (P = .008). There was a significant decrease in residual urine vo lume, from 163 mL +/- 162 to 68 mL +/- 59 (P = .05), whereas bladder c apacity remained relatively unchanged at 253 mL +/- 181 and 230 mL +/- 97 (P = .30). Complications included one case of postoperative bleedi ng necessitating transfusion, two treatment failures, and one bulbous urethral stricture. Fourteen of the 17 patients (82%) now void without the aid of an indwelling catheter or alternative therapy. Balloon dil ation has no detrimental effect on erectile function and may improve f ertility.