**11. External sphincterotomy**

The efficacy of the sphincterotomy has been well documented since Emmett JL and Dunn JH described the trans-urethral resection of the bladder neck and prostate in SCI patients with outlet obstruction. Ross JC introduced the resection of the external urinary sphincter. Large series have shown that sphincterotomy is successful in the treatment of vesical outlet obstruction in certain male patients with quadriplegia, in order to reduce detrusor leak point pressure, followed by condom catheter drainage. Patients who develop UTIs after sphincterotomy are should undergo assessment of PVR to ensure adequate bladder emptying. Urodynamic testing should also be considered to assess the efficacy of the sphincterotomy. If there is evidence of urethral obstruction, repeat sphincterotomy may be indicated. Sphincterotomy can also be indicated when patients use Credé or Valsalva to empty their bladder, but first, surgeons must have assessed that the lower urinary tract is urodynamically safe and that the upper urinary tract is not damaged [91].

**13.2. Incontinent diversion**

**13.3. Undiversion**

urinary tract infection.

virulent microorganism

**15. Treatment**

If catheterization is impossible, incontinent diversion is indicated. The ileal conduit is the most common form of incontinent urinary diversion used. It could be considered in patients who show intractable and untreatable incontinence, in patients with LUT dysfunction, when the upper urinary tract is severely compromised and in patients who refuse other therapy [119]. An ileal segment is used for the deviation in most cases [120–124] and patients gain better functional status and quality of life [125]. Incontinent diversion has also an acceptable rate of complications. Especially in children, there are concerns about long-term effects on renal function, and while conduit diversion may be considered in this population, alternative methods may be preferable.

Urinary Tract Infections in Neuro-Patients http://dx.doi.org/10.5772/intechopen.79690 71

Long-standing diversions may be successfully undiverted or an incontinent diversion changed to a continent one with the cause of better techniques for control of detrusor pressure and incontinence [120]. The patient must be carefully counseled and must comply with the instruc-

Some patients with spinal cord injury have difficulty or are unable to perform IC through a native urethra. In such cases, the creation of an abdominal stoma using a continent catheterizable channel (CCC) should be considered. A CCC is particularly helpful in women because their ability to access their urethra is more difficult than in men [127–129]. A concomitant bladder neck closure with a CCC becomes an option when urethral dysfunction or destruc-

The majority of patients with bladder augmentation or continent urinary diversion will have mucus production that can act as an incubation material for infection. Irrigation of the bladder or pouch at regular intervals with normal saline decrease the incidence of symptomatic

Generally, asymptomatic bacteriuria does not require treatment because the microorganism cannot be eliminated or will recur after the treatment is complete. In addition, antimicrobial therapy will lead to resistant strains of microorganisms [130, 131]. Therefore, there is no indication that treatment reduces virulence or mortality. Systemic antimicrobial therapy for

• treatment may be a part of the control of a hospital infection due to a particular prevalent

tions [120]. Only then successful undiversion can be performed [126].

tion does not result in acceptable continence over anti-incontinence surgeries.

asymptomatic bacteriuria is recommended only in special cases such as:

• patients who undergo urological surgery or prosthetic graft

**14. Continent catheterizable channel**
