Bladder sphincter dyssynergia
| Bladder sphincter dyssynergia | |
|---|---|
Urodynamic trace of detrusor sphincter dyssynergia
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-9-CM | 596.55 |
| Patient UK | 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] 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
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found. Urination disorders occur in 80% patients with multiple sclerosis (MS). Most common of them is detrusor-sphincter dyssynergia (DSD).
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ [1] 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
- ↑ [2] 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
- [3] Lua error in package.lua at line 80: module 'strict' not found.
- [4] Pressure Flow Study, Department of Urology, Southern General Hospital, Glasgow
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