Surgical treatment for urinary incontinence arising from neurogenic bladder

The pathologies causing urinary incontinence in neurogenic bladder are high intravesical pressure either due to hyper-reflexia or low bladder compliance, and low urethral resistance due to patent bladder neck and/or impaired sphincter function. Sometimes these are coexistent, and in order to correct any of these pathologies, intermittent catheterization becomes necessary to conquer urinary retention. During the past 14 years, 24 cases of saddle block for hyperreflex bladder, 23 periurethral Teflon injections, 10 cases of suspension surgery, 7 urethral ligations for patent urethra and 136 cases of penile prosthesis for external condom drainage have been attempted in order to control urinary incontinence with self-intermittent catheterization. Saddle block and urethral ligation for female incontinence and penile prosthesis for male incontinence appeared to be valuable maneuvers for improving the QOL of these patients with uncontrollable neurogenic incontinence. On the other hand, periurethral Teflon injection and suspension surgery proved to be hopeless methods for curing such severe cases of incontinence.