Division of the External Sphincter 1

Summary Division of the external sphincter may be required for obstruction at that level with or without evidence of spasticity. In supra‐sacral lesions with good detrusor contractions there is normally no indication for a bladder neck resection and, when necessary, external sphincterotomy can confidently be carried out as a primary procedure. In sacral lesions, bladder neck resection may be required as a substitute for the normal opening mechanism, and this may have to be followed by division of an obstructive but non‐spastic external sphincter region. The operation shows up favourably as regards simplicity, safety, effectiveness and freedom from complications when compared with the alternative procedures which have been suggested.