1983 Volume 74 Issue 4 Pages 566-575
From June 1979, when the Spinal Cord Injuries Center, Iizuka was established, to August 1981, we carried out transurethral anterior sphincterotomy (Tu-Sp) 33 times on 29 male patients with spinal cord injuries among 155 inpatients treated in our Center. These 29 males could not void satisfactorily due to dysfunction of the urethral sphincter. Indications for Tu-Sp were determined by the following investigation: 1) A voiding synchronous cystosphincterometry with uroflowmetry: in combination with 2) Bladder, urethral and rectal pressures 3) Uroflowmetry and 4) Anal electromyography. This combination reveals the bladder and urethral function, viz. detrusor muscle and sphincter function during voiding. We have found this urodynamic study to be of great value in evaluating the function of the lower urinary tract in spinal cord injured patients.
The results were as follows:
1) Tu-Sp is indicated for the dysfunction of the external urethral sphincter.
2) If the indication for Tu-Sp was obtained it should be carried out as soon as possible.
3) Division at the 12 o'clock position on the external sphincter was enough for this purpose.
4) After Tu-Sp the pressure in the membraneous urethra and residual urine were decreased.
5) Detrusor muscle activity was weakened and duration of contraction was shortened.
6) All the patients voided satisfactorily after operation.
7) Although urinary incontinence was increased post Tu-Sp so-called total incontinence was not seen.
8) Every patient had bladder capacity ranging from 100 to 300ml postoperatively.
