Detrusor Sphincter Dyssynergia

Clinic

• DSD and Neurogenic Detrusor Overactivity (NDO) is a consequence of a neurological pathology such as spinal injury or MS
• Disruption CNS regulation of urination reflex resulting in dyscoordination of the detrusor muscles and Male/ Female external urethral sphincter muscles.
• The pathophysiology results from neuronal plasticity associated with bladder afferents and motor neurons innervating the external urethral sphincter.
• Normaly these two separate muscle structures act in synergistic coordination.
• During voiding urethral sphincter muscle relaxes completely, but in DSD, it contracts causing the flow to be interrupted and the bladder pressure to rise.

Overactive bladder (OAB) is a symptom syndrome consisting of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of a causative infection or pathological conditions. The prevalence of OAB is approximately 11-19% in both men and women

OAB is also associated with comorbidities such as urinary tract infection (UTI) and an increased risk of falls.

Neurogenic detrusor overactivity (NDO) is a bladder dysfunction frequently observed in patients with conditions such as multiple sclerosis (MS) and spinal cord injury (SCI). Increased storage pressure can put the upper urinary tract at risk of deterioration

Urinary incontinence (UI) is reported by approximately 50% of MS patients, and most of SCI patients.

Presentation

• Daytime and night time wetting
• Urinary retention
• History of urinary tract infections
• Constipation and encopresis are often associated with this condition
• Note that Pseudodyssynergia has different causes but presents similarly.