Contact laser sphincterotomy: further experience and longer follow-up

Spinal Cord
I Perkash

Abstract

I report here the use of a crystal chisel contact tip firing Nd:YAG laser for transurethral sphincterotomy in 76 consecutive spinal cord injury patients. Their mean age was 53 years (range 26 to 77 years). Fifty-four (72%) were complete motor (Frankel A and B) and 21(28%) were incomplete lesions (Frankel C and D) They were evaluated with multichannel urodynamic equipment and 89% of the patients showed detrusor sphincter dyssynergia and 11% showed detrusor areflexia. Forty-three patients (56%) had previous electrocautery sphincterotomy and were not voiding well. A cystoscopic examination showed that 32% had an associated enlarged prostate and/or bladder-neck stenosis and 32% had associated wide-body strictures in the bulbous urethra. The crystal chisel contact tip firing Nd:YAG laser almost mimicked a hot diathermy knife to create an intraurethral incision as well as vaporizing the tissues. For sphincterotomy, a 12 o'clock incision was used from the verumontanum to the bulbous urethra. In patients with an associated enlarged prostate or bulging lateral lobes, 3 and 9 o'clock incisions were also made from the bladder-neck to the verumontanum and also vaporized the bulging prostate tissue. We used 25 to 40 watts for cutting, and v...Continue Reading

References

Apr 1, 1987·Investigative Radiology·I Perkash, G W Friedland
Jan 1, 1986·The Journal of Urology·J L LockhartV A Politano
Jul 1, 1967·The British Journal of Surgery·J C RossM Damanski
Dec 1, 1994·The Journal of Urology·B SchurchA B Rossier
Sep 1, 1994·The Journal of Urology·M B ChancellorM P Chetner
Apr 1, 1994·The Journal of Urology·J M VapnekA R Stone

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Citations

Dec 16, 2006·International Journal of Clinical Practice. Supplement·D Castro-Diaz, J M Taracena Lafuente
Feb 24, 2009·The Journal of Urology·Inder Perkash
Sep 14, 2015·Topics in Spinal Cord Injury Rehabilitation·Allan J KozlowskiMarcel P Dijkers

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