Bladder-neck resection in the paraplegic—Report on over 100 cases

Abstract

1. The history of bladder-neck resection in paraplegia is outlined and the rationale of the operation is considered.

2. Indications and technique are reviewed, and the practice in the Liverpool Centre is illustrated by reference to 108 patients selected for bladder-neck resection out of the 484 cases of paraplegia from all causes admitted between the opening of the Centre in 1947 and March 1964.

3. The relative high incidence of bladder-neck resection (approximately 30 per cent. of the 372 male paraplegics at risk) and the relatively early resort to operation (nearly 50 per cent. within the first 12 months) at this Centre are noted. These features are attributed to the requirements of the rapid programme of physical rehabilitation established in recent years. (The average duration of stay of all new cases admitted in the past few years is four months.)

4. In our Centre repeated bladder-neck resection has not been so common as elsewhere, probably because of the confidence felt in division of the external sphincter as a supplementary procedure.

5. Complications have been few, and mainly associated with haemorrhage. There has been no operative mortality.

6. The early results of bladder-neck resection, supplemented occasionally by other procedures, have been satisfactory in 94 out of the 108 patients.

7. The long-term follow-up has shown that, excluding patients with progressive neurological disease and neglected cases with irreversible renal damage at the time of operation, the benefits of bladder-neck resection have been well maintained.

8. The necessity in a minority of patients for further operations to deal with recurrence of residual urine after many years emphasises the importance of a regular follow-up system.

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Gibbon, N., Ross, J. & Damanski, M. Bladder-neck resection in the paraplegic—Report on over 100 cases. Spinal Cord 2, 264–278 (1965). https://doi.org/10.1038/sc.1964.44

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