External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results

Background. - To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). Methods. - Retrospective, monocentric study, conducted in 51 patients who had a first ES bet-ween January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary out-comes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. Results. - The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n = 41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P < 0.001), urinary tract infections (UTI) (31 vs 15 patients, P < 0.001) and a significant decrease in post-voiding residuals (200 vs 50 mL, P < 0.001). Conclusion. - ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is man-datory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. Level of evidence.- III. (c) 2020 Elsevier Masson SAS. All rights reserved.