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RESECTION OF THE BLADDER NECK IN MULTIPLE SCLEROSIS: A Clinical and Pathophysiological Study

Within seven years, 139 patients with multiple sclerosis or allied disorders were treated with transurethral resection for stenosis of the bladder neck. Six‐month follow‐ups were performed in 134 patients alive at that time. At the follow‐up, one quarter of the patients were practically symptom‐free, and a total of three quarters were improved. The results were best in the group without incontinence. However, among 99 patients with urge incontinence, more than one third had become continent, and in another quarter the incontinence had decreased. After the resection, cystometry showed depression of the reflex activity in the detrusor muscle evidenced by reduced pressure and an increased threshold of the uninhibited contractions. It is reasonable to correlate this finding to the effect on urge incontinence. Bladderneck stenosis must be suspected in multiple sclerosis patients with difficulty in bladder emptying not referable to acute aggravation of the disease, and in patients with urge incontinence in whom drug therapy has not had a satisfactory effect. The least satisfactory results must be expected in patients in a poor general condition, or with rapid progression of the neurological manifestations, or with severe mental deterioration, but none of these conditions can be said to constitute a contra‐indication to resection.