An Explanation for the Persistence of Residual Urine After External Sphincterotomy

Nanninga, Jopin B.; O’Conor, Vincent J.; Rosen, Joel S.

doi:10.1016/s0022-5347(17)58207-5

Cited by 11 publications

(4 citation statements)

References 5 publications

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“…Despite the advantages mentioned, however, measurement of RESP is not a better predictor of sphincterotomy success than residual urine or DLPP. As a sufficiently sustained detrusor pressure is a prerequisite for sphincterotomy success [24] , a video-urodynamic evaluation is mandatory and can easily include DLPP measurement. Therefore, a routine use of RESP does not seem to be justified.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

et al. 2009

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Objective: Sphincterotomy is a well-established therapeutic option in male patients with neurogenic bladder dysfunction and detrusor-sphincter-dyssynergia due to spinal cord lesions. Indication and prediction of treatment outcome, however, are mainly based on clinical parameters. We analyzed the clinical usefulness of preoperative urodynamic evaluation for the prediction of success in patients undergoing external sphincterotomy. Materials and Methods: In a retrospective study, residual urine, retrograde perfusion pressure (RESP) and detrusor leak point pressure (DLPP) in 62 male patients with spinal cord injury were assessed before sphincterotomy. Data were compared to surgical success evaluated by postoperative DLPP and residual urine. Results: Sphincterotomy was successful in 85.4% of our patients. In multivariate analysis, both preoperative DLPP and RESP were superior to measurement of residual urine concerning prediction of surgical success. However, these differences were not statistically significant. Conclusion: To our knowledge, this is the first study to evaluate preoperative predictors for surgical success in patients undergoing sphincterotomy. Although urodynamic evaluation is strongly advised prior to surgery in patients with spinal cord lesions, it improves prediction of success only marginally.

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Section: Discussionmentioning

confidence: 99%

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

et al. 2009

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“…Out of the men with detrusor hyperre¯exia (n=42), 84% had a successful sphincterotomy and 16% did not. 21 Nanninga et al 22 thought that persistence of residual urine after sphincterotomy may be due to loss of Barrington's urethrovesical re¯ex, whereby stimulation of the posterior urethra by the passage of urine sustains the detrusor contraction. Seven patients with residual urine volumes above 80 ml after sphincterotomy underwent urodynamic evaluation and all demonstrated poorly sustained detrusor contractions.…”

Section: Predicting Failure Of External Sphincterotomymentioning

confidence: 99%

“…All seven patients demonstrated a sustained detrusor pressure during voiding pre-operatively. Nanninga et al 22 did not determine whether poorly sustained detrusor contractions identi®ed pre-operatively could be used to predict the presence of elevated residual urine volumes post-operatively.…”

Section: Predicting Failure Of External Sphincterotomymentioning

confidence: 99%

Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects

et al. 2002

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Study design: Literature review of current treatment options for detrusor ± sphincter dyssynergia (DSD) in spinal cord injury. Objectives: To review the outcomes and complications associated with external sphincterotomy and to summarise the results and complications of alternative treatment options for detrusor ± sphincter dyssynergia in spinal cord injury. In addition, we propose a potential alternative future drug treatment for external sphincter dyssynergia based upon recent research on the neuropharmacology of the external urethral sphincter. Setting: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Methods: Medline search from 1966 to 2002 using the words`external sphincterotomy', detrusor ± sphincter dyssynergia' and`neurogenic bladder combined with surgery'. Results: While external sphincterotomy is an eective treatment for DSD, a signi®cant number of men following this procedure continue to have high intrarenal pressures, recurrent urinary infection or troublesome autonomic dysre¯exia and a worryingly high proportion demonstrate persistently raised leak point pressures, putting them at subsequent risk of renal damage. Alternative treatments for external sphincter dyssynergia include urethral stents and balloon dilatation, both of which are eective. However, over the long term stents can undergo encrustation and there remains a de®nite risk of stent migration necessitating stent removal or replacement. Balloon dilatation of the external sphincter is associated with a risk of subsequent stricture formation. Intraurethral Botulinum A toxin seems to be eective though there have been no large randomised studies comparing it against placebo. However, it is not a durable treatment option and it has not found a common place in the treatment of DSD. There is now a considerable amount of experimental data from both animal and human studies to suggest that nitric oxide (NO) is an important physiological inhibitory neurotransmitter in the urethral sphincter, mediating relaxation of the external urethral sphincter. The potential role of sphincter NO augmentation for treatment of DSD is discussed. Conclusion: External sphincterotomy remains the mainstay of treatment for urodynamically signi®cant detrusor ± sphincter dyssynergia, but in recent years a number of eective, alternative treatment options have become available. While at present there is no eective systemic drug treatment, recent research into external sphincter neuropharmacology suggests that systemic or topical augmentation of external sphincter NO may provide an eective method for lowering sphincter pressure.

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“…External condom drainage can also be used safely [ 26] if the dyssynergia is of short duration. Prolonged dyssynergia may require bladder augmentation or external sphincterotomy [ 27]. Low bladder compliance requires anticholinergics and intermittent catheterization, and may need bladder augmentation if intravesical pressure remains high.…”

Section: Specific Diseases and Their Effects On The Bladdermentioning

confidence: 99%

Neurological disorders in the ageing population and their urological implications

Evans

Castleden

1998

British Journal of Urology

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An Explanation for the Persistence of Residual Urine After External Sphincterotomy

Cited by 11 publications

References 5 publications

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects

Neurological disorders in the ageing population and their urological implications

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