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Detrusor-external sphincter dyssynergia.
M B Chancellor1, S A Kaplan, J G Blaivas
1Department of Urology, College of Physician and Surgeons, Columbia University, New York, NY 10032.
Ciba Foundation Symposium
|January 1, 1990
Summary
Detrusor-external sphincter dyssynergia (DESD) involves involuntary sphincter contractions during bladder emptying due to neurological issues. Effective management, including self-catheterization, is crucial to prevent serious urological complications, especially in men.
Area of Science:
- Urology
- Neuroscience
- Physiology
Background:
- Detrusor-external sphincter dyssynergia (DESD) is a condition where the external urethral sphincter involuntarily contracts during detrusor muscle contractions.
- It stems from neurological damage affecting the brainstem and sacral spinal cord, seen in conditions like spinal cord injury and multiple sclerosis.
Purpose of the Study:
- To describe the different types of DESD and outline current treatment strategies.
- To highlight the potential urological complications associated with untreated DESD.
Main Methods:
- Classification of DESD into three types based on detrusor pressure and sphincter electromyography (EMG) patterns.
- Review of treatment options including pharmacological or surgical bladder modification and intermittent self-catheterization.
- Discussion of surgical interventions like external sphincterotomy for specific patient groups.
Main Results:
- DESD presents in three types: Type 1 (sphincter relaxation at peak contraction), Type 2 (sporadic sphincter contractions), and Type 3 (continuous sphincter obstruction).
- Treatment focuses on achieving continence via detrusor inhibition and bladder emptying through self-catheterization.
- Men with DESD face over a 50% risk of severe urological complications within five years if untreated, a risk less common in women.
Conclusions:
- DESD is a complex neurogenic bladder dysfunction requiring tailored management strategies.
- Prompt and appropriate treatment, particularly intermittent self-catheterization, is vital for preventing long-term urological morbidity in men.
- Understanding the different DESD types aids in selecting the most effective therapeutic approach.