Bladder sphincter dyssynergia
| Bladder sphincter dyssynergia | |
|---|---|
 Urodynamic trace of detrusor sphincter dyssynergia | |
| Classification and external resources | |
| ICD-9 | 596.55 |
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] that 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] On cystography there is an irregular appearance of the bladder outline due to muscular contraction against the unrelaxed bladder sphincter.[5]
Pathology and symptoms
The pathophysiology of the condition results from neuronal plasticity associated with bladder afferents and motor neurons innervating the external urethral sphincter. Symptomatically, 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.
Diagnosis
Strictly DSD can only be diagnosed from an EMG trace or x-ray findings, but the urodynamic trace in the image shows both the pressure and flow phenomena mentioned.[6]
Treatment
Botulinum A toxin is a valuable alternative for patients with spinal cord injury who can not perform self catheterisation or do not want surgical methods.[7]
References
- ↑ Manfred Stohrer et al. (1999). "The Standardization of Terminology in Neurogenic Lower Urinary Tract Dysfunction". Neurourology and Urodynamics 18 (2): 139–158. doi:10.1002/(SICI)1520-6777(1999)18:2<139::AID-NAU9>3.0.CO;2-U. PMID 10081953.
- ↑ Karsenty G et al. (2005). "Understanding detrusor sphincter dyssynergia--significance of chronology". Urology 66 (4): 763–8. doi:10.1016/j.urology.2005.04.061. PMID 16230135.
- ↑ E Iu Stankovich, V V Borisov, T L Demina (1999). "Tamsulosin in the treatment of detrusor-sphincter dyssynergia of the urinary bladder in patients with multiple sclerosis". Urologiia: 48–51. ISSN 1728-2985. Urination disorders occur in 80% patients with multiple sclerosis (MS). Most common of them is detrusor-sphincter dyssynergia (DSD).
- ↑ Corcos, Jacques; Schick, Erik (2004). Textbook of the neurogenic bladder: adults and children. Informa Health Care. pp. 163–168. ISBN 1-84184-206-0.
- ↑ Cystometry shows Neurogenic detrusor overactivity is overactivity in the presence of confirmed neuropathy in this case Multiple Sclerosis, Doug Small, Department of Urology, Southern General Hospital, Glasgow
- ↑ Cystometry shows High detrusor pressure and interrupted. Can not diagnose dyssynergia without emg or radiology but this trace is suggestive of dyssynergic voiding; Doug Small, Department of Urology, Southern General Hospital, Glasgow
- ↑ http://jnnp.bmj.com/content/63/4/474.full
External links
- Lester M. Libo (1983). "EMG biofeedback for functional bladder-sphincter dyssynergia: A case study". Applied Psychophysiology and Biofeedback 8.
- Pressure Flow Study, Department of Urology, Southern General Hospital, Glasgow
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