Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries.

Purpose: Detrusor sphincter dyssynergia (DSD) and bladder neck dysfunction (BND) may cause voiding dysfunction in patients with spinal cord injury (SCI). We report the surgical outcomes in patients with high-level SCI who underwent transurethral incision of the bladder neck (TUI-BN). Patients and Methods: Twenty-two patients with SCI at or above the mid-thoracic level who presented with voiding dysfunction due to BND with different types of DSD received TUI-BN. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentations. Satisfactory outcome was defined as having improvement of AUA/IPSS quality-of-life (QoL) index by >= 2. Results: Among the patients, 19 (86.4%) were men and 3 (13.6%) were women. Thirteen patients had cervical and nine had thoracic SCI. Postoperatively, spontaneous voiding by abdominal triggering with an open urethral sphincter was noted in 19 patients (86%) and AD had resolved in 15 patients (88.2%). Detrusor pressure decreased significantly in 9 patients who had a high voiding pressure at baseline, and increased significantly in 13 patients who showed impaired detrusor contractility preoperatively. Eighteen patients (82%) reported satisfactory outcome, increased maximum flow rate (Q(max)), decrease in postvoid residual (PVR) postoperatively. In addition, 82% of the patients were catheter free or reported a decrease in the frequency of clean intermittent catheterization after TUI-BN. Conclusions: TUI-BN is effective in restoring spontaneous voiding, increasing Q,a, and decreasing PVR in high-level SCI patients. TUI-BN also leads to improvement in reducing bladder outlet resistance, reduction in occurrence of AD episodes, and improvement in QoL. Neurourol. Urodynam. 29:748-752, 2010. (C) 2010 Wiley-Liss, Inc.