Adam E, Palamara C, Briant P E, Coste A C, Ruffion A
Service de chirurgie urologique, centre hospitalier Lyon Sud, 165, chemin du Grand Revoyet, 69310 Pierre Bénite, France; Université Claude-Bernard Lyon-1, 8, avenue Rockefeller, 69373 Lyon, France.
Prog Urol. 2013 Dec;23(17):1500-4. doi: 10.1016/j.purol.2013.07.017. Epub 2013 Aug 28.
To evaluate middle term results of surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia.
Retrospective study about 44 patients whom underwent urinary sphincterotomy between January 2008 and September 2012. All patients had detrusor-sphincter dyssynergia. Mean age was 49.7 years. Seventy percent (n=30) of patients had spinal cord injury, 80% (n=34) underwent urethral stent. Sphincterotomy was performed in 55% (n=24) with monopolar resection and in 43% (n=19) with Revolix(®) laser, after urethral stent withdrawal.
Mean follow-up was 30 months. Mean hospitalization stay was 5 days. Mean preoperative post-voiding residue (PVR) was 149mL and postoperative was 176mL. Twenty-nine percent (n=13) underwent new sphincterotomy with a final mean 116mL PVR, and a mean delay before new sphincterotomy of 9 months. Twenty percent (n=9) underwent other surgical procedure for sphincterotomy fail.
In this series, we observed that surgical sphincterotomy is a well tolerated procedure, but with moderate immediate efficiency about 57%. It requires sometimes second procedure and long term follow-up in order not to fail to recognize stenosis, with best surgical success (80%).
评估手术括约肌切开术治疗伴有逼尿肌-括约肌协同失调的神经源性膀胱功能障碍的中期结果。
对2008年1月至2012年9月间接受尿括约肌切开术的44例患者进行回顾性研究。所有患者均有逼尿肌-括约肌协同失调。平均年龄为49.7岁。70%（n = 30）的患者有脊髓损伤，80%（n = 34）的患者接受了尿道支架置入术。在拔除尿道支架后，55%（n = 24）的患者采用单极切除术进行括约肌切开术，43%（n = 19）的患者采用Revolix（®）激光进行括约肌切开术。
平均随访30个月。平均住院时间为5天。术前平均排尿后残余尿量（PVR）为149mL，术后为176mL。29%（n = 13）的患者接受了再次括约肌切开术，最终平均PVR为116mL，再次括约肌切开术前的平均延迟时间为9个月。20%（n = 9）的患者因括约肌切开术失败而接受了其他手术。
在本系列研究中，我们观察到手术括约肌切开术耐受性良好，但即刻有效率中等，约为57%。有时需要二次手术和长期随访，以避免未能识别狭窄，最佳手术成功率为80%。
