Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition

A total of 27 men with multiple sclerosis underwent urodynamic evaluation as part of a prospective study of voiding dysfunction. Of 18 patients with detrusor-external sphincter dyssynergia 9 suffered serious urologic complications, including repeated episodes of urosepsis, vesicoureteral reflux and urolithiasis. None of the 9 patients without dyssynergia suffered any urologic complications. Urologic complications were correlated highly to the presence of detrusor-external sphincter dyssynergia and the severity of multiple sclerosis but not to duration of multiple sclerosis, age of the patient or type of dyssynergia. Although no treatment was without complications it appears that either anticholinergics plus intermittent self-catheterization or condom catheter drainage is superior to an indwelling catheter for initial conservative treatment. External sphincterotomy or urinary diversion may be necessary if conservative therapy fails.