What are the surgical options for outlet obstruction in the treatment of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Transurethral resection of the bladder neck is indicated in patients who have obstruction at the bladder neck when medical therapy has failed to produce satisfactory results.

External sphincterotomy is indicated in patients who have suprasacral lesions that cause failure to empty when other therapeutic modalities have not been successful. Candidates for this procedure should have adequate detrusor contractions.

Stenting makes use of removable stents inserted into the urethra via cystoscopy. Indications are similar to those for sphincterotomy.

Urethral overdilation is performed only in females and has the same objective as sphincterotomy. [28]

An external compressive procedure involves the creation of a fascial sling around the bladder neck, using a fascial strip from either the rectus abdominis or tensor fasciae latae.

Implantation of an artificial sphincter is most commonly performed in children with myelomeningocele who have an incompetent sphincter mechanism.


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