Bladder sphincter dyssynergia

Bladder sphincter dyssynergia (also known as detrusor sphincter dysynergia (DSD) (the ICS standard terminology agreed 1998)[1] and neurogenic detrusor overactivity (NDO)) is a consequence of a neurological pathology such as spinal injury[2] or multiple sclerosis.[3] 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.[4]

Bladder sphincter dyssynergia
Urodynamic trace of detrusor sphincter dyssynergia
SpecialtyUrology 

Presentation

People with this condition generally experience daytime and night time wetting, urinary retention, and often have a history of urinary tract and bladder infections. Constipation and encopresis are often associated with this condition.

Pathology

The pathophysiology of the condition results from neuronal plasticity associated with bladder afferents and motor neurons innervating the external urethral sphincter.

Treatment

Botulinum A toxin is a valuable alternative for patients who do not want surgical methods.[5]

References
  1. Stöhrer M, Goepel M, Kondo A, Kramer G, Madersbacher H, Millard R, Rossier A, Wyndaele JJ (1999). "The standardization of terminology in neurogenic lower urinary tract dysfunction: with suggestions for diagnostic procedures. International Continence Society Standardization Committee". Neurourology and Urodynamics. 18 (2): 139–58. doi:10.1002/(SICI)1520-6777(1999)18:2<139::AID-NAU9>3.0.CO;2-U. PMID 10081953.
  2. Karsenty G, Reitz A, Wefer B, Boy S, Schurch B (October 2005). "Understanding detrusor sphincter dyssynergia--significance of chronology". Urology. 66 (4): 763–8. doi:10.1016/j.urology.2005.04.061. PMID 16230135.
  3. Stankovich EI, Borisov VV, Demina TL (2004). "[Tamsulosin in the treatment of detrusor-sphincter dyssynergia of the urinary bladder in patients with multiple sclerosis]". Urologiia (4): 48–51. PMID 15457955. Urination disorders occur in 80% patients with multiple sclerosis (MS). The most common of them is detrusor-sphincter dyssynergia (DSD),
  4. Corcos J, Schick E (2004). Textbook of the neurogenic bladder: adults and children. Informa Health Care. pp. 163–168. ISBN 978-1-84184-206-6.
  5. Schurch B, Hodler J, Rodic B (October 1997). "Botulinum A toxin as a treatment of detrusor-sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections". Journal of Neurology, Neurosurgery, and Psychiatry. 63 (4): 474–6. doi:10.1136/jnnp.63.4.474. PMC 2169779. PMID 9343126.

Further reading
  • Libo LM, Arnold GE, Woodside JR, Borden TA, Hardy TL (June 1983). "EMG biofeedback for functional bladder-sphincter dyssynergia: a case study". Biofeedback and Self-Regulation. 8 (2): 243–53. doi:10.1007/BF00998854. PMID 6357288.
Classification



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