Detrusor sphincter dyssynergia
What is it?
Bladder sphincter dyssynergia is a consequence of a neurological pathology such as spinal injury or multiple sclerosis which disrupts central nervous system regulation of the micturition (urination) reflex resulting in dyscoordination of the detrusor muscles of the bladder and the male or female external urethral sphincter muscles. In normal lower urinary tract function, these two separate muscle structures act in synergistic coordination. But in this neurogenic disorder, the urethral sphincter muscle, instead of relaxing completely during voiding, dyssynergically contracts causing the flow to be interrupted and the bladder pressure to rise.
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Detrusor sphincter dyssynergia.
Additional names
This group contains additional names:
- Bladder sphincter dyssynergia
- DSD
Signs & symptoms
Patients with DSD usually present with lower urinary tract symptoms (LUTS), frequently complaining about problems with voiding and/or storage. Symptoms generally include chronic urinary retention, intermittent voiding, and irregular small volume voiding or incontinence without an associated urge to void (reflex incontinence). Neurological symptoms may be predominant and lead to neurological workup initially. DSD is only likely to be found if there is some neurologic disorder affecting the central nervous system.
Diagnosis
The general approach to the diagnosis begins with a basic investigation of lower urinary tract symptoms to rule out common causes. Urine culture and sensitivity should be done if there is a suspicion of UTI. Besides serum electrolytes, urea & creatinine should also be measured. A 24-hour urine voiding diary will help characterize the voiding dysfunction. Ultrasonography and computed tomography (CT) scan imaging can be helpful for the assessment of hydronephrosis, reflux, urinary calculi, and post-void residual urine volumes, although they will not specifically help diagnose DSD.
The diagnosis of DSD is made through a urodynamic study with or without fluoroscopy via electromyography (EMG), voiding cystourethrogram, video urodynamics, or urethral pressure profile measurements. Cystoscopy is often recommended to rule out any urethral strictures which might affect these studies. The diagnosis of DSD by electromyography requires finding increased EMG sphincter activity during a detrusor contraction, in the absence of Valsalva or Crede maneuvers. Typical voiding cystourethrogram findings include a closed bladder neck during filling with subsequent dilation of the bladder neck and proximal urethra to the level of the external urinary sphincter during micturition.
DSD may be suggested by the finding of a plateau level of voiding detrusor pressure, but this is not diagnostic by itself without confirmation.
Urethral pressures are used as an adjunctive tool for diagnosing DSD. A 7 French urodynamic catheter, with independent bladder and urethral pressure sensors, is placed with the urethral sensors at the point of maximal sphincter pressure in the proximal urethra. DSD is then defined as an acute urethral pressure rise >20 cm of water during or immediately prior to a voluntary or involuntary detrusor contraction.
Treatment
Botulinum A toxin is a valuable alternative for patients who do not want surgical methods
☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.
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