Treatment of the neuropathic bladder by enterocystoplasty and selective sphincterotomy or sphincter ablation and replacement.

Sixty-one patients with lower urinary tract neuropathy were treated surgically, either to achieve continence or to prevent or arrest renal deterioration, or both. Most were myelodysplastics and all but two were ambulatory. Three techniques were employed, depending on the detrusor/sphincter behaviour and the sex of the patient: enterocystoplasty alone, with or without selective sphincterotomy and/or intermittent self-catheterisation; total sphincter ablation and an artificial sphincter; or, most commonly, enterocystoplasty combined with sphincter ablation and an artificial sphincter. Continence was achieved in 58 patients, though nocturnal enuresis was sometimes a problem; renal deterioration was arrested in 13 of 14 patients and renal function remained stable in all of the other patients.