Evaluación de la esfinterotomía anteromedial en la disfunción miccional refractaria a tratamiento médico en la mujer

Objective: To evaluate the efficacy of sphincterotomy in women diagnosed with voiding dysfunction. Materials and methods: We included patients with voiding dysfunction undergoing sphincterotomy within October 1993 to December 2008, analyzing symptoms and urodynamic variables baseline and postoperative complications. Results: We reviewed the records of 162 women with voiding dysfunction with sphincterotomy. We included 116 with urodynamic studies baseline and follow-up completed. The average age was 44.8 ± 13.2 years. The International Prostate Symptom Index baseline was 56% severe and at 12 months 9.5% (p < 0.000). Sixty-one women had urinary incontinence at baseline, 55.7% with stress component and 44.3% with emergency component, at 6 months 72 had some form of incontinence, 68% with stress component, 32% with urgency component (p = 0.03), a year later only 65 continued with some form of incontinence, 64.6% had stress incontinence component (in 3 patients it was corrected with surgery incontinence in this period) and 35.4% with urgency component (p = 0.07). Finally, 22 patients required an anti incontinence surgery (median 20 months). Conclusions: The anteromedial sphincterotomy is a useful procedure in patients with impaired bladder emptying, providing symptomatic and urodynamics improvement. If urinary stress incontinence increased however, it can be resolved by surgery.