WHAT IS NEW IN DETRUSOR-SPHINCTER DYSSYNERGIA TREATMENT IN SPINAL-CORD INJURY PATIENTS

Unbalanced bladder function represents one of the main problems in spi nal cord injured patients. Bladder outlet obstruction, especially detr usor-sphincter dyssynergia, is the principal cause of impaired voiding . Currently, intermittent self-catheterization with eventual additiona l anticholinergic drugs is the best conservative method to achieve low pressure voiding and continence. Electrical stimulation to empty the bladder is possible at various stimulation sites: the bladder wall, th e pelvic nerves, the sacral roots and the spinal cord. With respect to electrode application, stimulation of the sacral roots is most attrac tive. Several selective procedures aiming to overcome the concomitant stimulation-induced external urethral sphincter contractions have been described. Some. of these are widely used and doing well in humans (p ost-stimulus voiding principle), whereas others are still undergoing e xperimentation (collision blocks, anodal blocks, quasitrapezoidal impu lse). Whatever the choosen method, electrical stimulation of the bladd er is to be reserved for selected cases. If the introduction of the se lf-catheterization failed, sphincterotomy remained, until recently, th e only alternative to overcome detrusor-sphincter dyssynergia. However , post-operative complications and long-term failure are not infrequen t. Botulinum-A injections into the external urethral sphincter to indu ce partial paralysis, represents an attractive alternative to surgical sphincterotomy. Easiness of the method and satisfactory long-term res ults have encouraged physicians to use it more often in neurogenic voi ding disorders. Reversibility and innocuousness of the procedure enhan ced patients acceptance. (C) 1998 Elsevier Science Ireland Ltd.