Balloon dilatation of the external urethral sphincter in the treatment of detrusor-sphincter dyssynergia

Balloon dilatation of the external urethral sphincter was introduced in our unit in 1990 as an alternative to sphincterotomy in the surgical management of detrusor-sphincter dyssynergia in spinally injured patients. The initial results with the technique looked promising. We performed 14 balloon dilatations in the period 1990-1993, and these patients have been followed up for 8-68 months (mean 55.5). The procedure was effective in relieving symptoms and had a low morbidity. Sphincter activity assessed at cystoscopy was initially abolished in all patients. Vesicoureteric reflux present in one patient pre-operatively resolved after the procedure. However the long-term results are disappointing, with an 85% failure rate (62% within 1 year). Balloon dilatation in our series has a lower success rate than both sphincterotomy and sphincter stenting and cannot be recommended for the treatment of detrusor-sphincter dyssynergia.