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Management of detrusor–external sphincter dyssynergia

Nature Clinical Practice Urology volume 3, pages 368–380 (2006)Cite this article

Abstract

Detrusor–external sphincter dyssynergia (DSD) is a debilitating problem in patients with spinal cord injury. DSD carries a high risk of complications, and even life expectancy can be affected. The mainstay of treatment is the use of antimuscarinic medication and catheterization, but in those for whom this is not possible external sphincterotomy has been the traditional management route. External sphincterotomy, however, is associated with significant risks, including hemorrhage, erectile dysfunction and the need for repeat procedures, and over the last decade alternatives have been investigated, such as urethral stents and botulinum toxin injection. We present a review of DSD, including the current management strategies and prospects for future treatment.

Key Points

  • Up to 50% of patients with untreated detrusor–external sphincter dyssynergia (DSD) can develop serious urologic complications

  • Videourodynamic studies provide diagnostic confirmation of DSD; a leak-point pressure of >40 cmH2O is predictive of upper urinary tract damage

  • The principles of DSD management are to reduce intravesical pressure and aid bladder emptying

  • A combination of antimuscarinic agents and clean, intermittent self-catheterization seems to be the simplest method of treatment, but might not be suitable for all patients with spinal cord injury

  • Historically, external sphincterotomy was the standard treatment, but may be associated with significant complications

  • Newer, minimally invasive techniques such as urethral stents and botulinum toxin treatment seem to be safe and efficacious, but long-term data are lacking

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Author information

Authors and Affiliations

  1. Clinical Research Fellow in Urology,

    Hashim U Ahmed, Iqbal S Shergill, Manit Arya & P Julian R Shah

  2. Specialist Registrar in Urology,

    Hashim U Ahmed, Iqbal S Shergill, Manit Arya & P Julian R Shah

  3. Specialist Registrar in Urology,

    Hashim U Ahmed, Iqbal S Shergill, Manit Arya & P Julian R Shah

  4. Consultant Neurourologist and Senior Lecturer in Neurourology,

    Hashim U Ahmed, Iqbal S Shergill, Manit Arya & P Julian R Shah

  5. Institute of Urology and Nephrology, University College London, London, UK

    Hashim U Ahmed, Iqbal S Shergill, Manit Arya & P Julian R Shah

Authors
  1. Hashim U Ahmed
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  2. Iqbal S Shergill
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  3. Manit Arya
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  4. P Julian R Shah
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Corresponding author

Correspondence to Iqbal S Shergill.

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The authors declare no competing financial interests.

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Ahmed, H., Shergill, I., Arya, M. et al. Management of detrusor–external sphincter dyssynergia. Nat Rev Urol 3, 368–380 (2006). https://doi.org/10.1038/ncpuro0521

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