Introduction and Patient Selection for Surgery

Abstract

With currently available treatment modalities it is possible to replace the entire urinary tract. The only requirement is a functioning kidney. The ureter and bladder can be replaced by gut, the urethra by skin and the sphincter mechanisms by an artificial device (for example). Fortunately, such extensive surgery is rarely required, but the fact remains that it is possible to make anybody continent, regardless of the nature of their problem.

• 1. What is required to restore or produce continence and adequate voiding with respect to the patient’s adequately evaluated and objectively demonstrated urodynamic abnormalities?

• 2. Is the surgical intervention required justifiable with regard to the patient’s general condition, circumstances and motivation?

Given that, in general, a patient with neuropathic dysfunction has more than one urodynamic abnormality and will usually therefore need more than one kind of treatment, the process of selection of patients for surgery involves an initial selection of patients in whom such surgery is warranted, then a decision as to which abnormalities require surgical intervention and, finally, a decision as to which procedure or procedures will be needed to correct those abnormalities.