In the management of the neurogenic bladder of spinal cord injured patients, intermittent catheterization, stimulation and Credé-Valsava methods have been used. If bladder training is not successful, it is effective to try drugs or a surgical method. Especially, external sphincterotomy introduced by Ross(1957) reduces the resistance of the urethra by a deep incision of the external sphincter, and it is known to be effective for both reflexic and areflexic bladders.
In this study, we have done physical examination, voiding cystourethrogram and cystometrogram on 16 spinal cord injured patients with external sphincterotomy to determine the effects and complications of external sphincterotomy.
In three patients whose postvoiding volume of residual urine(PVR) was more than 100 cc, postoperative PVR was decreased by less than 100 cc in all patients. In two patients whose maximal detrusor pressure(MDP) was more than 100 cmH2O, postoperative MDP was decreased in all patients. In ten patients who had vesicoureteral reflux(VUR), VUR disappeared in six patients postoperatively. Postoperative bleeding was present in all patients, but it disappeared in two weeks. Urinary incontinence was developed in six patients, but was negligible.
According to the above results, we concluded that if external sphincterotomy is done for appropriate cases, it may be helpful for the management of the neurogenic bladder of spinal cord injured patients.
